Lesión renal aguda y nefritis intersticial aguda debido a picadura por escorpión: reporte de caso / Acute kidney injury and acute interstitial nephritis due to scorpion sting: a case report / Lesão renal aguda e nefrite intersticial aguda devido a picadura por escorpião: reporte de caso

El envenenamiento debido a picadora de escorpiones es reportado en diferentes países de Suramérica, en algunos, como México, es un problema de salud pública. En Colombia el accidente por escorpiones no es de reporte obligatorio, por lo que hay subregistro de casos. Los accidentes por este tipo de animales ponzoñosos se asocian a manifestaciones locales, y en casos de gravedad moderada a severa, a problemas cardiovasculares y neurológicos. Sin embargo, es importante reconocer manifestaciones que, aunque reportadas con menos frecuencia, implican gran morbilidad, como la pancreatitis y las alteraciones renales, entre las que está la nefritis. Se reporta el caso de un varón de 46 años, que presentó un accidente por Tytus, con nefritis intersticial. Este es el primer reporte de esta complicación en Colombia. Nuestro objetivo principal es resaltar la importancia de una pronta identificación de casos y un oportuno inicio del tratamiento por parte del personal de la salud, que permitan disminuir la morbilidad y mortalidad de estos pacientes.

Scorpion poisoning is reported in different countries in South America, especially in Mexico, where it has become a public health issue. In Colombia this type of accident is not mandatory to report, therefore, there is underreporting of cases. Accidents caused by these poisonous animals are mainly associated with local manifestations and, in cases of moderate to severe severity, to cardiovascular and neurological problems. Nevertheless, it is important to recognize other manifestations which, despite being reported less frequently, are associated with high morbidity such as pancreatitis and renal alterations, among which is nephritis. The case of a 46-year-old male patient is reported, who had an accident due to Tytus and presented interstitial nephritis. This is the first report of this complication in Colombia, and based on this, the main objective is to highlight the importance of prompt identification and treatment by health personnel, in order to reduce morbidity and mortality in these patients.

O envenenamento devido a picadora de escorpiões é reportado em diferentes países da América Latina, em alguns, como México, é um problema de saúde pública. Na Colômbiao acidente por escorpiões não é de reporte obrigatório, porque há sub-registro de casos. Os acidentes por este tipo de animais peçonhentos se associam a manifestações locais, e em casos de gravidade moderada a severa, a problemas cardiovasculares e neurológicos. Entretanto, é importante reconhecer manifestações que, embora reportadas com menos frequência, implicam grande morbilidade, como a pancreatite e as alterações renais, entre as que está a nefrite. Se reporta o caso de um homem de 46 anos, que apresentou um acidente por Tytus, com nefrite intersticial. Este é o primeiro reporte desta complicação na Colômbia. Nosso objetivo principal é ressaltar a importância de uma breve identificação de casos e um oportuno início do tratamento por parte do pessoal da saúde, que permitam diminuir a morbilidade e mortalidade destes pacientes.

Molecular transduction in receptor-ligand systems by planar electromagnetic fields / Transdução molecular em sistemas receptor-ligante por campos electromagnéticos planares

The coupling of a ligand with a molecular receptor induces a signal that travels through the receptor, reaching the internal domain and triggering a response cascade. In previous work on T-cell receptors and their coupling with foreign antigens, we observed the presence of planar molecular patterns able to generate electromagnetic fields within the proteins. These planes showed a coherent (synchronized) behavior, replicating immediately in the intracellular domain that which occurred in the extracellular domain as the ligand was coupled. In the present study, we examined this molecular transduction - the capacity of the coupling signal to penetrate deep inside the receptor molecule and induce a response. We verified the presence of synchronized behavior in diverse receptor ligand systems. To appreciate this diversity, we present four biochemically different systems - TCR-peptide, calcium pump-ADP, haemoglobin-oxygen, and gp120-CD4 viral coupling. The confirmation of synchronized molecular transduction in each of these systems suggests that the proposed mechanism would occur in all biochemical receptor-ligand systems.

A ligação de um ligante com um receptor molecular induz um sinal que viaja através do receptor, chegando ao domínio interno e disparando uma cascata de resposta. Em trabalhos anteriores em receptores de células T e sua ligação com antígenos estranhos, observamos a presença de padrões moleculares planares capazes de gerar campos eletromagnéticos dentro das proteínas. Esses planos mostraram um comportamento coerente (sincronizado), replicando, instantaneamente, no domínio intracelular o que ocorreu no domínio extracelular, enquanto o ligante era acoplado. No presente estudo, examinamos essa transdução – a capacidade de um sinal de acoplamento de penetrar profundamente a molécula receptora e induzir uma resposta. Verificamos a presença de um comportamento coerente em sistemas diversos de receptor-ligante. Para apreciar essa diversidade, apresentamos quatro sistemas bioquímicos diferentes: TCR-peptídeo, ADP-bomba de cálcio, hemoglobina-oxigênio e gp120-CD4 acoplamento viral. A confirmação de transdução molecular sincronizada em cada um desses sistemas sugere que o mecanismo proposto ocorreria em todos os sistemas bioquímicos receptor-ligante.

Molecular transduction in receptor-ligand systems by planar electromagnetic fields

Abstract The coupling of a ligand with a molecular receptor induces a signal that travels through the receptor, reaching the internal domain and triggering a response cascade. In previous work on T-cell receptors and their coupling with foreign antigens, we observed the presence of planar molecular patterns able to generate electromagnetic fields within the proteins. These planes showed a coherent (synchronized) behavior, replicating immediately in the intracellular domain that which occurred in the extracellular domain as the ligand was coupled. In the present study, we examined this molecular transduction - the capacity of the coupling signal to penetrate deep inside the receptor molecule and induce a response. We verified the presence of synchronized behavior in diverse receptor-ligand systems. To appreciate this diversity, we present four biochemically different systems - TCR-peptide, calcium pump-ADP, haemoglobin-oxygen, and gp120-CD4 viral coupling. The confirmation of synchronized molecular transduction in each of these systems suggests that the proposed mechanism would occur in all biochemical receptor-ligand systems.

Resumo A ligação de um ligante com um receptor molecular induz um sinal que viaja através do receptor, chegando ao domínio interno e disparando uma cascata de resposta. Em trabalhos anteriores em receptores de células T e sua ligação com antígenos estranhos, observamos a presença de padrões moleculares planares capazes de gerar campos eletromagnéticos dentro das proteínas. Esses planos mostraram um comportamento coerente (sincronizado), replicando, instantaneamente, no domínio intracelular o que ocorreu no domínio extracelular, enquanto o ligante era acoplado. No presente estudo, examinamos essa transdução a capacidade de um sinal de acoplamento de penetrar profundamente a molécula receptora e induzir uma resposta. Verificamos a presença de um comportamento coerente em sistemas diversos de receptor-ligante. Para apreciar essa diversidade, apresentamos quatro sistemas bioquímicos diferentes: TCR-peptídeo, ADP-bomba de cálcio, hemoglobina-oxigênio e gp120-CD4 acoplamento viral. A confirmação de transdução molecular sincronizada em cada um desses sistemas sugere que o mecanismo proposto ocorreria em todos os sistemas bioquímicos receptor-ligante.

Molecular transduction in receptor-ligand systems by planar electromagnetic fields / Transdução molecular em sistemas receptor-ligante por campos electromagnéticos planares

The coupling of a ligand with a molecular receptor induces a signal that travels through the receptor, reaching the internal domain and triggering a response cascade. In previous work on T-cell receptors and their coupling with foreign antigens, we observed the presence of planar molecular patterns able to generate electromagnetic fields within the proteins. These planes showed a coherent (synchronized) behavior, replicating immediately in the intracellular domain that which occurred in the extracellular domain as the ligand was coupled. In the present study, we examined this molecular transduction - the capacity of the coupling signal to penetrate deep inside the receptor molecule and induce a response. We verified the presence of synchronized behavior in diverse receptorligand systems. To appreciate this diversity, we present four biochemically different systems - TCR-peptide, calcium pump-ADP, haemoglobin-oxygen, and gp120-CD4 viral coupling. The confirmation of synchronized molecular transduction in each of these systems suggests that the proposed mechanism would occur in all biochemical receptor-ligand systems.

A ligação de um ligante com um receptor molecular induz um sinal que viaja através do receptor, chegando ao domínio interno e disparando uma cascata de resposta. Em trabalhos anteriores em receptores de células T e sua ligação com antígenos estranhos, observamos a presença de padrões moleculares planares capazes de gerar campos eletromagnéticos dentro das proteínas. Esses planos mostraram um comportamento coerente (sincronizado), replicando, instantaneamente, no domínio intracelular o que ocorreu no domínio extracelular, enquanto o ligante era acoplado. No presente estudo, examinamos essa transdução ­ a capacidade de um sinal de acoplamento de penetrar profundamente a molécula receptora e induzir uma resposta. Verificamos a presença de um comportamento coerente em sistemas diversos de receptor-ligante. Para apreciar essa diversidade, apresentamos quatro sistemas bioquímicos diferentes: TCR-peptídeo, ADP-bomba de cálcio, hemoglobina-oxigênio e gp120-CD4 acoplamento viral. A confirmação de transdução molecular sincronizada em cada um desses sistemas sugere que o mecanismo proposto ocorreria em todos os sistemas bioquímicos receptor-ligante.

Daños de salud respiratoria en comunas expuestas a centrales termoeléctricas a carbón en el norte de Chile: análisis de datos secundarios / Respiratory health damage in communes exposed to coal-fired power plants in northern Chile

INTRODUCCIÓN: En Chile, el funcionamiento de las Centrales Termoeléctricas de Carbón (CTEC) representan un problema de salud pública debido a las consecuencias sanitarias que tienen en la población. Se han notificado daños en el sistema respiratorio. Materiales y MÉTODOS: Se realizó un estudio ecológico, para evaluar los egresos hospitalarios de las personas que viven en las ciudades donde operan las CTEC (Tocopilla y Huasco), se comparó con una ciudad de control sin CTEC (Caldera), las comunas evaluadas tienen condiciones sociodemográficas similares. Se calcularon las tasas de morbilidad y tasas de morbilidad estandarizadas (SMR). RESULTADOS: La tasa de morbilidad por enfermedades respiratorias en Tocopilla (2016) fue de 152,5 por 10.000 habitantes (habs) y para Huasco es de 135,2 por 10.000 habs. En la ciudad control, Caldera, la tasa es de 40,9 por 10.000 habs. Además, los habitantes de Tocopilla tienen 2,42 más riesgo de padecer bronquitis o bronquiolitis, 90% más riesgo de presentar enfermedades crónicas de las vías respiratorias bajas y 2,14 veces más riesgo de enfermar por asma. En Huasco, la población tiene 2,49 veces más riesgo de padecer enfermedades de las vías respiratorias inferiores con respecto a la región y 3,19 veces más riesgo de presentar asma. CONCLUSIONES: El asma y la bronquitis, son las patologías que mostraron mayores riesgos en las ciudades de Tocopilla y Huasco. Nuestros hallazgos son similares a otras investigaciones realizadas en comunidades expuestas a centrales termoeléctricas de carbón. Es necesario tomar medidas urgentes para proteger la salud de la población.

INTRODUCTION: In Chile, coal-fired power plants (CTEC) operate represents public health problems due to the health consequences for the population. Damage to the respiratory system is reported. MATERIALS AND METHODS: Ecological study to evaluate hospital discharges in people living in cities where CTEC operates (Tocopilla and Huasco) were compared to a control city without CTEC (Caldera), all of them with similar sociodemographic conditions. Morbidity rates and Standardized Morbidity Ratios (SMR) were calculated. RESULTS: The respiratory disease morbidity rate in Tocopilla (2016) was 152.5 per 10,000 inhabitants (habs) and for Huasco it is 135.2 per 10,000 inhabitants. In the control city, Caldera, the rate is 40.9 per 10,000 habs. In addition, the inhabitants of Tocopilla have a 2.42 times increased risk of bronchitis or bronchiolitis, 90% higher risk of chronic lower respiratory diseases and 2.14 times more risk of asthma sickness. In Huasco, the population is 2.49 times more at risk of lower respiratory diseases compared to the region and 3.19 times more at risk of asthma. CONCLUSIONS: Asthma and bronchitis are the pathologies that showed the greatest risks in the cities of Tocopilla and Huasco. Our findings are similar to other research conducted in communities exposed to coal-fired power plants. Urgent action is needed to protect the health of the population.

Caracterización del módulo salud del sistema 123: atención de accidentes de tránsito en la ciudad de Medellín / Characterization of the health module of the 123 system for traffic accident attention in the city of Medellín / Caracterização do módulo saúde do sistema 123: atenção de acidentes de trânsito na cidade de Medellín

Objetivo: Caracterizar la atención de accidentes de tránsito en la ciudad de Medellín para obtener una imagen general de la situación de salud en este contexto. Metodología: Estudio descriptivo observacional, con intención analítica, de fuentes secundarias de información, en pacientes con edad mayor o igual a 16 años, atendidos por el personal 123, módulo salud, víctimas de accidentes de tránsito en Medellín. Resultados: Un total de 3 829 individuos sufrieron accidente de tránsito entre octubre y diciembre del 2018 según los criterios del estudio. De estos, el 63.1% de sexo masculino, con edad media de 34 años. La zona con mayor demanda de atención prehospitalaria fue la comuna 10 de la ciudad (La Candelaria) y la mayoría de los afectados por los accidentes lo fueron en calidad de conductor, 64%, y en un 75% de los casos, el vehículo involucrado fue una motocicleta. Solo el 26.5% de los pacientes fueron dados de alta en la escena. Las extremidades fueron las zonas corporales de mayor compromiso, en un 78.2% de los episodios, seguidas por el cráneo y la cara, con un 26.8%. Conclusiones: Es evidente la necesidad de la ciudad de implementar y evaluar el impacto de estrategias dinámicas que permitan un manejo eficiente de los recursos, que priorice las zonas y grupos demográficos de mayor riesgo y la articulación de la disposición de pacientes dentro de la cadena de atención, según los tipos más frecuentes de lesiones.

Objective: To characterize the traffic accident attention in the city of Medellín in order to obtain a general image of the health situation in this context. Methodology: Observational descriptive study, with analytic intent, of secondary information sources in patients with age higher or equal to 16 years of age, served by the 123 personnel, health module, who were victims of traffic accidents in Medellín. Results: A total of 3 829 individuals suffered traffic accidents between October and December of 2018 according to the study criteria. Of these, 63.1% were males, with an average age of 34 years old. The zone with the highest demand of pre-hospital attention was the Comuna 10 of the city (known as La Candelaria) and most of the affected by the accidents were as drivers, 64%, and 75% of the cases, the vehicle involved was a motorcycle. Only 26.5% of the patients were discharged on the scene. The extremities were the body zones with the highest compromise in 78.2% of the episodes, followed by the cranium and the face, with 26.8%. Conclusions: It is evident that the city needs to implement and evaluate the impact of dynamic strategies that enable an efficient management of the resources that prioritizes the zones and demographic groups with the highest risk and the articulation of the disposition of patients within the attention chain, according to the most frequent types of injuries.

Objetivo: Caracterizar a atenção de acidentes de trânsito na cidade de Medellín para obter uma imagem geral da situação de saúde neste contexto. Metodologia: Estudo descritivo observacional, com intenção analítica, de fontes secundárias de informação, em pacientes com idade maior ou igual a 16 anos, atendidos pelo pessoal 123, módulo saúde, vítimas de acidentes de trânsito em Medellín. Resultados: Um total de 3 829 indivíduos sofreram acidente de trânsito entre outubro e dezembro de 2018 segundo os critérios do estudo. Destes, 63.1% de sexo masculino, com idade média de 34 anos. A região com maior demanda de atenção pré-hospitalar foi a comuna 10 da cidade (La Candelaria) e a maioria dos afetados pelos acidentes foram em qualidade de condutor, 64%, e num 75% dos casos, o veículo envolvido foi uma motocicleta. Só 26.5% dos pacientes foram dados de alta na cena. As extremidades foram as zonas corporais de maior compromisso, em 78.2% dos episódios, seguidas pelo crâneo e a cara, com um 26.8%. Conclusões: É evidente a necessidade da cidade de implementar e avaliar o impacto de estratégias dinâmicas que permitam um manejo eficiente dos recursos, que priorize as zonas e grupos demográficos de maior risco e a articulação da disposição de pacientes dentro da cadeia de atenção, segundo os tipos mais frequentes de lesões.

Exposición a contaminantes provenientes de termoeléctricas a carbón y salud infantil: ¿Cuál es la evidencia internacional y nacional? / Exposure to contaminants from coal-fired thermoelectric plants and children's health: what is the international and national evidence?

Resumen: Las centrales termoeléctricas (CTE) a carbón representan un riesgo para la salud de las comunidades expuestas. Se realizó una revisión de la literatura científica nacional e internacional enfocada en los efectos en salud de niños y la exposición a emisiones al aire provenientes de CTE a carbón. Se inclu yeron 21 artículos para su revisión en texto completo, donde se midieron efectos en salud infantil relacionados a presencia de biomarcadores de exposición y efecto, daños perinatales, neuroconductuales y respiratorios principalmente. La exposición a emisiones de CTE a carbón en el embarazo se asoció a niños con bajo peso y muy bajo peso al nacer, menor talla, menor diámetro de Circunfe rencia del Cráneo (CC) y prematuridad; el diámetro de CC aumentó en recién nacidos después del cierre de CTE. Se encontraron menor coeficiente de desarrollo (CD) y coeficiente intelectual (CI) en niños expuestos a emisiones de CTE a carbón comparados con no expuestos; CD aumentó cuando la central fue cerrada. Por otro lado, vivir en zonas con fuentes de emisión de mercurio (asociadas a CTE y plantas de cemento que funcionan con carbón) se asoció con mayor riesgo de autismo. En salud respiratoria, los artículos fueron consistentes en reportar menor función pulmonar en niños residentes en zonas expuestas a fuentes de combustión de carbón comparados con grupos de niños no expuestos. Es muy necesario abrir el debate en Chile sobre los riesgos controlables a los que se enfrenta la población infantil a consecuencia de plantas generadoras de energía instaladas en Chile.

Abstract: Coal-fired power plants (CFPP) represent a health risk to the exposed communities. A review of national and international scientific literature was made focused on the health effects on children and exposure to air emissions from CFPP. Twenty-one articles were included for full-text review, where effects on child health mainly related to the biomarkers presence of exposure and effect, pe rinatal, neurobehavioral and respiratory damages were measured. Exposure to CFPP emissions in pregnancy was associated with low birth weight and very low birth weight, shorter height, smaller head circumference (HC) diameter, and prematurity; the HC diameter increased in newborns after the CFPP closure. Lower coefficient of development (CD) and intelligence quotient (IQ) were found in children exposed to CFPP emissions compared with unexposed ones; CD increased when the plant was closed. On the other hand, living in areas with mercury emission sources (associated with CFPP and cement plants that work with coal) was associated with an increased risk of autism. In respira tory health, the articles were consistent with reporting lower pulmonary function in children living in areas exposed to coal combustion sources compared with groups of unexposed children. There is a great need to open the debate in Chile on the controllable risks faced by the child population as a result of power generation plants located in Chile.

Imágenes en divertículos del tubo digestivo: localizaciones infrecuentes. serie de casos / Imaging in infrequent digestive diverticula: case series

Los divertículos se pueden localizar en todo el tubo digestivo (TD): esófago, estómago, duodeno, yeyuno, íleon, apéndice, colon. Son infrecuentes, salvo en colon. Sus manifestaciones clínicas son inespecíficas, con difícil diagnóstico y mayor riesgo de complicaciones. Se presenta una serie de divertículos digestivos atípicos, mostrando las características imagenológicas multimodalidad y describir los hallazgos claves. Es una revisión retrospectiva en el archivo computacional de nuestra institución. Selección de casos de divertículos de presentación inhabitual por sus características, localización u origen. En esófago los divertículos de Zenker y Killian-Jamieson. En estómago los divertículos gástricos infrecuentes. Los divertículos en intestino delgado tienen baja prevalencia, el más frecuente en duodeno. Los divertículos colónicos pueden tener una localización o presentación atípica. Los divertículos apendiculares y Meckel presentan baja prevalencia. Los divertículos digestivos son infrecuentes, excepto los colónicos. El radiólogo debe estar familiarizado con las diferentes ubicaciones de ellos, para reconocerlos y poder diagnosticarlos.

Diverticula may occur in any segment of the digestive tract: esophagus, stomach, duodenum, jejunum, ileum, appendix, and colon. Its clinical manifestations are nonspecifi which may turn diffiult an early diagnosis, leading to a higher risk of complications. We present a cases serie of atypical digestive diverticula and to describe the fidings on the different imaging techniques. We performed a retrospective review on the imaging computer archives of our institution. The atypical diverticula were selected. Zenker and Killian-Jamieson's diverticulums in esophagus. In stomach ocasionally gastric diverticula. Diverticula in small intestine have a low prevalence, the most common location is duodenum. Colonic diverticula may present a atypical location or presentation. The appendicular and Meckel diverticuli are uncommon. The digestive diverticula are uncommon, except the colonic ones. The radiologist must be familiar with it's different locations in order to be able to recognize it and diagnose it properly.

Exposición a nitratos en agua y su relación con disfunción de la glándula tiroides: revisión sistemática ¿Existen riesgos para la salud de la población? / Exposure to nitrates in drinking water and its association with thyroid gland dysfunction

Background: Nitrate exposure may be associated with thyroid gland dysfunction. Aim: To review the available evidence about the relationship between nitrates in drinking water and thyroid gland dysfunction. Material and Methods: A wide search was performed using Medline, Cochrane, Lilacs, IBECS and Scielo databases using pertinent keywords, finding a total of 66 related studies. After filtering and in depth reviewing, a total of 12 studies were included in this review. Results: The main results reveal the importance of this ion for human health, finding evidence both in animals and human beings that suggest pathological changes in the gland as its relationship with the occurrence of subclinical hypothyroidism, and potentially cancer of the thyroid gland. In Chile, nitrate is not considered a critical contaminant so its regular measuring and control is not enforced. Conclusions: In light of the present review we believe that there is evidence to consider nitrate as a critical contaminant whose measurement, registration and correct implementation of valid policies would have a direct benefit for the population of this country. Without this information, it is not possible to quantify the damage to human health, especially in vulnerable groups residing in areas at greatest risk of exposure.

Complicación respiratoria en el postoperatorio tardío en un paciente con distrofia miotónica tipo I. Reporte de un caso / Respiratory complication in the late postoperative period in a patient with type I myotonic dystrophy. Case report

Myotonic dystrophy is an uncommon disease, characterised by disorders of the muscle membrane. Its clinical manifestations are muscle weakness, difficulty at initiating movements and delayed muscle relaxation. Carriers of this disease are very sensitive to anaesthetic drugs. Residual neuromuscular blockade is common among these patients, leaving them at risk of various postoperative complications. Proper neuromuscular blockade reversal is therefore crucial. We report the case of an 18-year-old male with myotonic dystrophy type I (Steinert's disease), who was admitted for a complicated hydatid cyst. He required a laparotomy, which was done under general anesthesia with no intraoperative incidents. He was extubated at the end of the procedure, with 94% response at the train-of-four (TOF) and adequate spontaneous ventilation. No reversal for neuromuscular blockade was given. The patient evolved favourably during the postoperative phase. However, in the later postoperatory period the patient presented severe respiratory complications. Proper anaesthetic management of these patients, as described in the literature, includes the use of non-depolarising muscle relaxants, monitoring of muscle relaxation and reversal of neuromuscular blockade. The combination of rocuronium and sugammadex appears to convey the optimum reversal required for these cases.

Las distrofias miotónicas son enfermedades poco comunes, caracterizadas por trastornos a nivel de la membrana muscular. Clínicamente se manifiestan por debilidad muscular progresiva, dificultad al iniciar movimientos y retardo en la relajación muscular. Los portadores de este grupo de enfermedades tienen una marcada sensibilidad a los fármacos anestésicos. Es habitual que presenten bloqueo neuromuscular residual, arriesgándose a sufrir diversas complicaciones postoperatorias. Por ello, es importante realizar una reversión adecuada de la relajación muscular en estos pacientes. Presentamos el caso de un paciente masculino de 18 años, con distrofia miotónica de Steinert tipo I, que ingresa para laparotomía por quiste hidatídico hepático complicado. Recibió anestesia general sin incidentes. Es extubado con una respuesta al tren-de-cuatro (TOF) de 94% y ventilación espontánea adecuada. No se realiza reversión del bloqueo neuromuscular y evoluciona favorablemente en el postoperatorio inmediato. Sin embargo, en el período postoperatorio tardío, presenta complicaciones respiratorias severas. El adecuado manejo de estos pacientes, según lo recomendado en la literatura, requiere el uso de relajantes no-depolarizantes, monitorización y reversión del bloqueo neuromuscular, siendo probablemente la combinación de rocuronio y sugammadex, la más adecuada para estos fines.

Evaluation of the supplementation of a feed additive as a potential protector against the adverse effects of 2. 5 ppm T-2 toxin on growing broiler chickens / Avaliação da suplementação de um aditivo alimentar como um protetor potencial contra os efeitos adversos de 2, 5ppm de toxina T-2 em frangos em crescimento

A trial was conducted to evaluate a feed additive containing epoxidase activity from a bacterium (Mycofix-S) as a potential protection against the adverse effects of 2.5 ppm dietary T-2 toxin in male growing broiler chickens. A total of 144 one-day-old Ross 308 male chicks were individually wing-banded and allotted into each of the four experimental groups. Group 1: negative control, no T-2 toxin or additive; group 2: Mycofix-S, 2.5 g/kg; group 3: positive control, 2.5 ppm T-2 toxin; group 4: 2.5 ppm T-2 toxin + 2.5 g/kg Mycofix-S. Feed and water were provided ad libitum for 28 days (days 1 to 28 of age). Each experimental treatment was replicated 6 times, with 6 birds per replicate pen. Response variables included performance parameters, serum activity of alkaline phosphatase (ALP) and amylase, relative weight of selected organs and histology of the upper digestive system. T-2 toxin at 2.5 ppm significantly (P = 0.016) decreased the 28-day body weight gain and cumulative feed intake without affecting feed conversion. The feed additive counteracted these adverse effects. Serum enzyme activities were not significantly (P>0.05) affected for the four experimental groups but when data from the groups receiving T-2 toxin was pooled and compared against the pooled data from groups without the toxin a significant decrease in amylase activity was observed in chickens receiving T-2 toxin. The histological examination of the upper digestive system revealed lesions in mouth, esophagus, proventriculus, gizzard and duodenum in the chickens fed T-2 toxin without the additive. Chickens fed T-2 toxin plus the additive showed lesions in the same tissues except in the duodenum. The results of the present study show that the addition of 2.5 g/kg of the feed additive tested protects against adverse effects on performance and also the integrity of the duodenal mucosa.(AU)

Foi realizado um experimento com o objetivo de avaliar um aditivo alimentar contendo atividade de epoxidase de uma bactéria (Mycofix-S) como proteção potencial contra os efeitos adversos de uma dieta com 2,5ppm de toxina T-2 em frangos de corte machos. Um total de 144 pintos machos Ross 308 de um dia de idade foram marcados na asa individualmente e alocados em um de quatro grupos experimentais: grupo 1: controle negativo, sem toxina T-2 ou aditivo; grupo 2: 2,5g/kg de Mycofix-S; grupo 3: controle positivo, 2,5ppm de toxina T-2; grupo 4: 2,5ppm de toxina T-2 + 2,5g/kg de Mycofix-S. Alimento e água foram fornecidos ad libitum por 28 dias (dias um a 28 de idade). Cada tratamento experimental foi replicado seis vezes, com seis pintos por gaiola de replicação. As variáveis de resposta incluíram parâmetros de desempenho, atividade sérica de fosfatase alcalina (ALP) e amilase, peso relativo de órgãos selecionados e histologia do sistema digestivo superior. A toxina T-2 a 2,5ppm diminuiu significativamente (P = 0.016) o ganho de peso corporal aos 28 dias e o consumo de alimento acumulado, sem afetar a conversão alimentar. O aditivo diminuiu os efeitos adversos. As atividades séricas das enzimas não foram afetadas significativamente (P>0.05) nos quatro grupos experimentais, porém, quando os dados dos grupos que receberam a toxina T-2 foram combinados e comparados com o pool de dados dos grupos sem toxina, foi observado um decréscimo significativo da atividade de amilase nos frangos que receberam a toxina T-2. O exame histológico do sistema digestivo superior revelou lesões em boca, esôfago, pró-ventrículo, moela e duodeno nos frangos alimentados com toxina T-2 sem aditivo. Frangos alimentados com toxina T-2 mais aditivo mostraram lesões nos mesmos tecidos, exceto no duodeno. Os resultados do presente estudo mostram que a adição de 2,5g/kg do aditivo alimentar testado protege contra os efeitos adversos sobre o desempenho e a integridade da mucosa duodenal.(AU)

Gastrectomía en manga: estudio por imágenes de sus complicaciones / Laparoscopic sleeve gastrectomy: imaging study of its complications

The incidence of obesity in Chilean adult population reaches up to 25.1 percent, according to statistics from 2013. Bariatric surgery is an alternative that has proven weight loss and resolution of comorbidities significant long term. For this reason are routine procedures in different health institutions. However, its massification and safety are not free of complications, which can be detected and treated early with the help of radiological images. The aim of this paper is to describe the most common postoperative complications of the sleeve gastrectomy and its diagnosis using different imaging techniques, mainly fluoroscopic study contrasted of the the esophagus-stomach-duodenum and contrasted enhanced computed tomography (CT) of the abdomen and pelvis. Bariatric surgeries are now routine procedures for treatment of morbid obesity. Knowledge of early and late complications and diagnosis of these using different imaging techniques allow adequate treatment, control and decreased postoperative morbidity and mortality.

La incidencia de obesidad en la población adulta chilena alcanza hasta un 25,1 por ciento, de acuerdo a cifras del año 2013. Las cirugías bariátricas son una alternativa que ha demostrado una baja de peso y resolución de comorbilidades significativas a largo plazo. Por este motivo son procedimientos rutinarios en las diferentes instituciones de salud. No obstante su masificación y seguridad, no están exentas de complicaciones, las que se pueden detectar y tratar precozmente con la ayuda de imágenes radiológicas. El objetivo de este trabajo es describir las complicaciones postquirúrgicas más frecuentes de la gastrectomía en manga y el diagnóstico mediante diferentes técnicas de imagen, principalmente el estudio fluoroscópico contrastado del esófago-estómago-duodeno y tomografía computada (TC) contrastada de abdomen y pelvis. El conocimiento de las complicaciones tempranas y tardías, así como el diagnóstico de éstas mediante las diferentes técnicas de imagen permitirá un adecuado tratamiento, control post operatorio y disminución de la morbimortalidad.

Esófago en cascanueces/sacacorchos en el espasmo esofágico / Nutcracker/corkscrew esophagus in the esophageal spasm

The nutcracker esophagus, also known as corkscrew esophagus, describes the abnormally segmented appearance of the esophagus in cases of esophageal spasm, displayed in the double contrast study. Normally the primary peristalsis extends through the esophagus like a coordinated contraction and relaxation wave. In the esophageal spasm multiple segments contract simultaneously and there is an alteration of the normal relaxation. Symptoms include chest pain, dysphagia, or both.

El esófago en cascanueces, también conocido como esófago en sacacorchos, describe la apariencia anormalmente segmentada del esófago en los casos de espasmo esofágico, visualizada en el estudio con doble contraste. Normalmente el peristaltismo primario se extiende a través del esófago como una onda coordinada de contracción y relajación. En el espasmo esofágico múltiples segmentos se contraen simultáneamente y hay una alteración de la relajación normal. Los síntomas incluyen dolor en el pecho, disfagia o ambos.

Percepciones de los cirujanos máxilofaciales chilenos acerca del doble grado médico-dental / Perceptions of chilean oral and maxillofacial surgeons about dual-degree

Introducción: El doble grado médico-dental (DG) en cirugía máxilofacial continúa siendo una cuestión controversial y sin resolver en muchos países, aunque hay una fuerte tendencia hacia su implementación en el mundo desarrollado. El objetivo de este trabajo es describir la percepción de los cirujanos máxilofaciales chilenos acerca del DG y su postura frente a la necesidad de implementarlo en el país. Metodología: Encuesta electrónica, realizada en la plataforma web LimeSurvey, incluyendo todos los cirujanos registrados en la Sociedad de Cirugía y Traumatología Bucal y Máxilofacial de Chile. El cuestionario incluyó 2 secciones: práctica quirúrgica y percepciones del DG. Resultados: 67 por ciento (61) cirujanos completaron la encuesta, la mayoría hombres, con más de 5 años de práctica quirúrgica y experiencia docente en la especialidad. 55,74 por ciento (34) consideran que la implementación de programas DG es necesaria en Chile. Hay asociación de la postura pro-DG y la práctica hospitalaria, conocimiento del doble grado, necesidad de mayores habilidades/conocimiento médico en la práctica diaria, necesidad del DG para practicar el campo completo de la especialidad y la opinión que los programas de especialización chilenos no están al nivel internacional. Conclusión: En Chile, como en otros países, hay una visión dicotómica del DG y parece perfectamente posible iniciar una discusión propositiva del tema.

Introduction: Dual-degree (DD) in oral and maxillofacial surgery still remains a controversial and/ or unsolved issue in many countries, although there is a growing trend towards its implementation in the developed world. The aim of this research is to describe the perceptions of Chilean oral and maxillofacial surgeons about DD and their position regarding the need of its implementation in Chile. Methodology: A cross-sectional survey was performed via the LimeSurvey web platform, included all surgeons registered in the Chilean Society. The questionnaire comprised two sections dedicated to surgical practice and perceptions about DD, respectively. Results: 67% (61) of surgeons completed the survey, main proportion men with more than 5 years of surgical practice, and experience in training teaching. 55.74% (34) considered the implementation of DD programs in Chile necessary. There are correlations between this pro-DD position and hospital practice, knowledge about DD, the need for more medical skills/knowledge in daily practice, the need for DD to perform the full scope of OMS, and the opinion that Chilean training programs are not practicing at an International level. Conclusion: In Chile, as in other countries, there is a dichotomic view of DD, and it appears absolutely possible to initiate a propositive discussion about it.

Brotes de enfermedades transmitidas por alimentos y agua en la Región Metropolitana, Chile (2005-2010) / Foodborne disease outbreaks around the urban Chilean areas from 2005 to 2010

Background: Foodborne disease outbreaks are one of the main health problems all over the world, which have an extensive impact on human health. Objetive: To analyze the foodborne disease outbreaks occurred in Chilean urban area from 2005 to 2010. Methods: We made a descriptive epidemiologic study. First, criteria were defined and classified according to previous epidemiologic investigations, clinical and environment samples, then. Variables of space, time, place and person were also analyzed. Results: Among 2,806 reported outbreaks, 2434 (86.7%) fulfilled the inclusion criteria. Incidence rate of the period (2005-2010) were 32 cases per 100 inhabitants. A total of 12,196 people were affected, with an average of 5 patients per outbreak. The households (36.2%), restaurants (16.3%), supermarkets (6.3%) free fair (4.4%) have been the most important outbreak areas. The foods involved were seafood (15.4%), fish (15.1%), and fast food (13.5%). The etiologic agents were Salmonella spp, Shigella spp, Vibrio parahaemolyticus. Conclusions: Outbreaks foodborne diseases are frequents in the Chilean urban area, which make vulnerable a lot of people. The largest numbers happened in the households and were due to bad handling and/or inappropriate storage of the foods.

Antecedentes: Las enfermedades transmitidas por alimentos (ETA) constituyen en el ámbito mundial, uno de los problemas sanitarios más comunes y de mayor impacto sobre la salud de las personas. Objetivo: Analizar los brotes de ETA notificados en la Región Metropolitana (RM) de Chile entre enero 2005 y junio 2010. Material y Métodos: Estudio epidemiológico descriptivo de base de datos de brotes de ETA que se clasificaron de acuerdo a encuesta epidemiológica y muestra clínica o ambiental. Se analizaron variables de espacio, tiempo, lugar y persona. Resultados: De los 2.806 brotes notificados, 2.434 (86,7%) cumplieron con los criterios de inclusión. Un total de 12.196 personas fueron afectadas, con un promedio de 5 enfermos por brote. La tasa de incidencia del período 2005-2010 fue 32 casos por 100 habitantes Los ámbitos de mayor brote fueron los hogares (36,2%), restaurantes (16,3%), supermercados (6,3%), ferias libres (4,4%). Los alimentos involucrados fueron mariscos (15,4%), pescados (15,1%), platos rápidos (13,5%). Los principales agentes etiológicos investigados fueron Salmonella spp, Shigella spp y Vibrio parahemolyticus. Conclusiones: Los brotes de ETA son muy frecuentes en la RM, comprometiendo un gran número de personas. La mayoría se produjeron en los hogares y fueron provocados por mala manipulación y/o conservación de los alimentos.

Hernia hiatal gigante con estómago intratorácico: reporte de un caso y revisión de la literatura / Giant hiatal hernia with intrathoracic stomach: a case report and literature review

Giant hiatal hernia (GHH) with intrathoracic stomach is a rare condition. It is a type 3 or mixed hernia (with sliding and paraesophageal component) with more than 30 percent of the stomach protruding into the chest cavity. These hernias are usually associated with gastric rotation, mostly with organoaxial twist. They have nonspecific clinical manifestations, which include vomiting, and chest or epigastric pain. Complications such as volvulus, perforation, or gastric obstruction constitute a medical emergency. In many cases, these hernias can be detected incidentally on a chest radiograph. Imaging studies, mainly multidetector CT and upper gastro-intestinal series represent vital tools for diagnosis and anatomical characterization of these lesions. The treatment of GHH requires an open or laparoscopic surgical approach. We report the case of a patient evaluated in our department who was diagnosed with giant hiatal hernia with intrathoracic stomach and organoaxial gastric rotation.

La hernia hiatal gigante (HHG) con estómago intratorácico es una enfermedad poco frecuente. Corresponde a una hernia tipo 3 o mixta (componente por deslizamiento y paraesofágico) que contiene más del 30 por ciento del estómago a nivel del tórax. Es común que estas hernias se asocien a rotación gástrica, preferentemente del tipo órgano-axial. Sus manifestaciones clínicas son inespecíficas e incluyen vómitos y dolor torácico o epigástrico. Pueden presentar complicaciones como vólvulo, perforación u obstrucción gástrica, constituyendo una emergencia médica. En muchos casos pueden ser detectadas en forma incidental en una radiografía de tórax. El estudio dirigido con imágenes, particularmente tomografía computada multidetector y estudio baritado esófago-estómago-duodeno, resultan fundamentales para el diagnóstico y caracterización de la anatomía de estas lesiones. El tratamiento es quirúrgico, sea por cirugía abierta o laparoscópica. Presentamos el caso de una paciente evaluada en nuestro servicio, en quien se realizó el diagnóstico de HHG con estómago intratorácico, con rotación gástrica órgano-axial.