Evaluación comparativa de la efectividad en el manejo del dolor posthemorroidectomia con tres estrategias farmacológicas diferentes

Introducción: La hemorroidectomía produce un intenso dolor postoperatorio recomendándose la analgesia multimodal para su manejo, manteniéndose como problema no resuelto. El objetivo fue evaluar la efectividad analgésica de tres combinaciones farmacológicas para el dolor post-hemorroidectomía. Materiales y Método: Estudio clínico prospectivo, aleatorizado, realizado en Clínica INDISA, entre diciembre 2019 y diciembre 2021, incluyendo pacientes con indicación de hemorroidectomía electiva. Se excluyeron hemorroidectomías asociadas a otro procedimiento quirúrgico, embarazadas/lactancia, reacciones adversas a medicamentos (RAM) a los fármacos en estudio, enfermedades hepáticas, renales o alteraciones/discapacidades mentales. Grupo I (control): Ketorolaco, Tramadol, Paracetamol. Grupo II: Grupo I y Nifedipino 0,2% tópico. Grupo III: Buprenorfina en parche 10 mcg/hora, Paracetamol y Ketorolaco. Asociado a régimen rico en fibra, polietilenglicol, baños de asiento y omeprazol. Se utilizó estadística descriptiva y analítica usando Chi-cuadrado, ANOVA-Bonferroni, Test de Kruskal Wallis, Wilcoxon y Fisher. Software R, utilizando un alfa del 5%. Resultados: De 117 pacientes, se enrolaron 39 = Grupo I, 41 = Grupo II y 37 = Grupo III. No hubo diferencias en la efectividad analgésica (p = 0,45). Para las RAM se observó que los pacientes con Buprenorfina tuvieron más náuseas (p = 0,08), vómitos (p = 0,04), dermatitis (p < 0,001) y prurito (p = 0,006). Discusión y Conclusiones: No hubo diferencias significativas para la efectividad analgésica post-hemorroidectomía al comparar los grupos de estudio. El uso de nifedipino tópico se recomienda como complemento a la terapia multimodal al mejorar los resultados sin aumentar las RAM. El uso de buprenorfina presentó más RAM sin mejores resultados como analgésico. El principal determinante para el alivio del dolor fue el tiempo transcurrido desde la cirugía.

Introduction: Hemorrhoidectomy produces intense postoperative pain, recommending multimodal analgesia for its management, remaining as an unresolved problem. The aim of this study was to evaluate the analgesic effectiveness of three pharmacological combinations for post-hemorrhoidectomy pain. Material and Method: A prospective, randomized clinical study, conducted at the INDISA Clinic, between December 2019 and December 2021, including patients with an indication for elective hemorrhoidectomy. Hemorrhoidectomies associated with another surgical procedure, pregnant/lactating women, adverse drug reactions (ADRs) to the study drugs, liver and kidney diseases, or mental disorders/disabilities were excluded. Group I (control): Ketorolac, Tramadol, Paracetamol. Group II: Group I and Nifedipine 0.2% topical. Group III: Buprenorphine patch 10 mcg/hour, Paracetamol and Ketorolac. Associated with a diet rich in fiber, polyethylene glycol, sitz baths, and omeprazole. Descriptive and analytical statistics were used using Chi-square, ANOVA-Bonferroni, Kruskal Wallis, Wilcoxon and Fisher test. Software R, using an alpha of 5%. Of 117 patients, 39 = Group I, 41 = Group II and 37 = Group III were enrolled. Results: There were no differences in analgesic effectiveness (p = 0.45). For the ADRs, it was observed that the patients with Buprenorphine had more nausea (p = 0.08), vomiting (p = 0.04), dermatitis (p < 0.001) and itching (p = 0.006). Discussion and Conclusion: There were no significant differences for post-hemorrhoidectomy analgesic effectiveness when comparing the study groups. The use of topical nifedipine is recommended as a complement to multimodal therapy as it improves results without increasing adverse drugs reaction (ADR).The use of buprenorphine presented more ADR without better results as an analgesic.The main determinant for pain relief was the time elapsed since surgery.

Métodos alternativos para determinação da potência de veneno e antiveneno botrópico: aplicações e perspectivas para o controle da qualidade / Alternative methods for potency evaluation for Bothrops venom and antivenom: applications and perspectives for quality control

Introdução: Acidentes com animais peçonhentos são classificados como doenças tropicais negligenciadas e são atualmente a mais frequente causa de intoxicação em humanos no Brasil. O único tratamento disponível é a rápida administração de antivenenos específicos e de qualidade garantida. Para assegurar a eficácia e a segurança desses produtos, são realizados ensaios de determinação da potência in vivo para veneno e antiveneno, desde as etapas de produção até sua liberação final. Apesar dos diversos estudos sobre métodos   alternativos ao ensaio murino, nenhum método foi efetivamente validado. Objetivo: Compilar os métodos alternativos desenvolvidos para os antivenenos botrópicos, avaliando sua disponibilidade, perspectivas e aplicações em laboratórios de produção e controle da qualidade. Método: Foi realizada uma busca nas bases PubMed, BVS e Scopus entre novembro de 2021 e junho de 2022. Foram identificados 89 trabalhos, dos quais 31 foram selecionados de acordo com os critérios de elegibilidade. Resultados: Nos métodos alternativos identificados, observamos a preferência de 42,80% dos estudos por metodologias que utilizem linhagens celulares como método alternativo aos ensaios murinos, sendo que a maioria destes trabalhos 58,30% optou pela linhagem celular Vero. Conclusões: Pela diversidade das toxinas encontradas em cada gênero de serpentes, entende-se que é de extrema importância que o ensaio de potência dos antivenenos tenha como base a avaliação e a quantificação precisa da inibição da atividade biológica dos venenos. Ensaios de citotoxicidade são amplamente utilizados e têm acumulado evidências de sua adequação como importante ferramenta alternativa ao ensaio murino para o controle da qualidade de veneno e antiveneno antibotrópico.

Introduction: Accidents with venomous animals are classified as neglected tropical diseases and are currently the most frequent cause of intoxication in humans in Brazil. The only available treatment is the rapid administration of specific, quality-assured antivenoms. To ensure the efficacy and safety of these products, in vivo potency determination tests for venom and antivenom are performed during the production stages, until final release. Despite several studies on alternative methods to the murine assay, no method has been effectively validated. Objective: To compile alternative methods developed for Bothrops antivenoms, assessing the availability of the methods and the prospects and applications in Bothrops venom and antivenom production and quality control laboratories. Method: A search was conducted in PubMed, BVS, and Scopus databases between November 2021 and June 2022. 89 articles were identified, of which 31 were selected according to the eligibility criteria. Results: We observed in the alternative methods identified a preference of 42.80% of the studies for methodologies that use cell lines as an alternative method to the murine assays, and most of these works (58.30%) opted for a VERO cell line. Conclusions: Due to the diversity of toxins found in each genus of snakes, it is understood that the potency assay for antivenoms should be based on the evaluation and precise quantification of the inhibition of biological activity of venoms. Cytotoxicity assays are widely used and have been accumulating evidence of their suitability as an important alternative tool to the murine assay for quality control for Bothrops venom and antivenom.

SARS-CoV-2 (COVID-19) en gestación y placenta: una revisión narrativa sobre el estado del arte / SARS-CoV-2 (COVID-19) in pregnancy and placenta: a narrative review on state of the art

Resumen La crisis sanitaria por la pandemia de COVID-19, enfermedad generada por la infección con el SARS-CoV-2, ha llevado a la pérdida de más de 25,000 vidas en Chile, con más de 370,000 mujeres entre 15 y 44 años con infección confirmada. Se ha reportado una mayor vulnerabilidad de las mujeres gestantes en cuanto a desarrollar cuadros de COVID-19 graves o críticos, con un aumento de la incidencia de resultados obstétricos y perinatales adversos. Es relevante considerar que un alto porcentaje de las gestantes infectadas con SARS-CoV-2 son asintomáticas, lo cual nos pone en alerta en cuanto a que ciertos efectos del virus durante la gestación podrían no ser evidentes para la observación clínica. Se ha demostrado la presencia de SARS-CoV-2 en la placenta, asociándose la infección placentaria con alteraciones vasculares que podrían afectar el flujo útero-placentario. Por otro lado, la transmisión vertical al feto parece que es poco frecuente, pero factible. Se resumen las evidencias disponibles hasta el momento sobre los principales efectos de la COVID-19 en la gestación, con énfasis en los estudios sobre los efectos de la infección por SARS-CoV-2 en la placenta. El objetivo es relevar el tema, destacando que son diversas las preguntas que necesitan ser abordadas, considerando el impacto que esta pandemia podría tener sobre la salud gestacional.

Abstract In Chile, the COVID-19 pandemic, a disease induced by infection with SARS-CoV-2, has caused more than 25,000 deaths. More than 370,000 women between 15 and 44 years have been detected with the infection. The greater vulnerability of pregnant women has been reported, mainly related to a higher risk for severe or critical COVID-19, with an increased incidence of adverse obstetrics and perinatal outcomes. It is relevant to consider that a high percentage of pregnant women infected with SARS-CoV-2 are asymptomatic for COVID-19, which indicates that specific effects of the virus during pregnancy may not be evident from clinical observation. The presence of SARS-CoV-2 in the placenta has been demonstrated, associating placental infection with vascular alterations that could affect utero-placental flow. On the other hand, vertical transmission to the fetus is rare but feasible. This manuscript summarizes the evidence available to date on the main effects of COVID-19 in pregnancy, emphasizing studies about the impact of SARS-CoV-2 in the placenta. This review aims to promote this issue, highlighting that several questions need to be addressed, considering the effect this pandemic could have on gestational health.

Improvement of endothelial function by Gunnera tinctoria extract with antioxidant properties

BACKGROUND: Gunnera tinctoria has been collected by Mapuche-Pewenche people for food and medicinal purposes. The high polyphenol content of methanolic extract from G. tinctoria leaves with chemical constituents such as ellagic acid and quercetin derivatives suggests its application to prevent endothelial dysfunction and oxidative stress. The aim of this study was to provide evidence of the protective effect of this extract on endothelial function by reducing oxidative stress induced by high D-glucose and H2O2, as well as by stimulating nitric oxide (NO) levels in human umbilical vein endothelial cells (HUVECs). RESULTS: A methanolic extract with a high content of polyphenols (520 ± 30 mg gallic acid equivalents/g dry extract) was obtained from G. tinctoria leaves. Its main constituent was ellagic acid. The results of Ferric reducing antioxidant power and 2,2-diphenyl-1-picrylhydrazyl radical scavenging assays of the extract confirmed its antioxidant activity by inhibition pathway of radical species. The incubation of HUVECs with the extract decreased the apoptosis and reactive oxygen species (ROS) synthesis induced by high extracellular concentration of D-glucose or hydrogen peroxide. The extract increased endothelial NO levels and reduced vasoconstriction in human placental vessels. CONCLUSIONS: This study provides evidence about the antioxidant and endothelial protective properties of methanolic G. tinctoria leaf extract. The extract improves the availability of NO in HUVECs, inhibiting the production of ROS and vasoconstriction.

El entrenamiento físico restaura la variabilidad del ritmo cardiaco en la insuficiencia cardiaca. Revisión sistemática / The exercise training restores the heart rate variability in heart failure patients. A systematic review

Resumen: Las enfermedades cardiovasculares constituyen una causa importante de morbi-mortalidad en la población general. En este sentido el desbalance autonómico forma parte del cuadro fisiopatológico que subyace al desarrollo de estas enfermedades. El objetivo de este estudio fue determinar el efecto del entrenamiento físico sobre la variabilidad del ritmo cardiaco (VRC) en pacientes con insuficiencia cardiaca. Metodología: Se realizó una revisión sistemática de la literatura. Fueron considerados ensayos clínicos con asignación aleatoria, estudios cuasiexperimentales con grupo control equivalente, estudios cuasiexperimentales sin grupo control y con análisis pre- y postintervención, y estudios cruzados, con períodos de entrenamiento y desentrenamiento asignados de manera aleatoria. Se calcularon las diferencias medias estandarizadas entre los parámetros de VRC pre- y postintervención para el grupo control y experimental. Resultados: En el análisis intrasujeto del grupo control, no se observó significación estadística en las diferencias medias estandarizadas entre el valor preintervención y el postintervención de los parámetro de VRC. En el grupo experimental, las diferencias medias estandarizadas fueron estadísticamente significativas para la raíz cuadrada del promedio de las diferencias al cuadrado entre intervalos R-R adyacentes (+0.468 ± 0.215; p = 0.032) y las bandas de alta (HF) (0.934 ± 0.256; p < 0.001) y baja (LF) (0.415 ± 0.096; p < 0.001) frecuencia; así como para el índice LF/HF (-0.747 ± 0.369; p = 0.044). Por otra parte, tan solo 3 estudios entraron en el metaanálisis de estudios comparativos. En el metaanálisis de estudios comparativos se observó un efecto favorable al grupo experimental para las variables: LF/HF (-2.21 ± IC 95%: -3,83 a -0.60), HF y LF. Conclusión: El entrenamiento físico fue efectivo en mejorar la VRC y restableció el balance autonómico en pacientes con insuficiencia cardiaca.

Abstract: Cardiovascular diseases are a significant cause of morbidity and mortality in the general population. In this sense, the autonomic imbalance is the cornerstone of the pathophysiology underlying the development of these diseases. The aim of this study was to determine the efficacy of exercise training on heart rate variability (HRV) in adult patients with chronic heart failure. Methodology: A systematic literature review was conducted in electronic databases. The considered studies were randomised clinical trials, quasi-experimental studies with non-randomised control group, quasi-experimental studies with analysis of pre- and post- intervention, and crossover studies with randomly assigned training and non-training periods. The standardised mean differences were calculated between pre- and post-intervention in both the control and experimental group. Results: Within-subject analysis of the control group showed no statistical significance in the standardised mean differences of HRV. In the experimental group, the standardised mean differences were positive for the root mean square of successive difference (+0.468 ± 0.215; P = .032), high frequency band (HF) (0.934 ± 0.256; P < .001) and low frequency band (LF) (< 0.415 ± 0.096; P = .001). Moreover, the standardised mean difference was negative for LF/HF (-0.747 ± 0.369, P = <.044). On the other hand, only 3 studies entered the comparative meta-analysis. The effect of exercise training was favourable for the experimental group in LF/HF (-2.21 ± 95% CI: -3.83 to -0.60), HF, and LF. Conclusion: The exercise training was effective in increasing HRV and restoring the autonomic balance in patients with heart failure.

Laboratory evaluation of Clusia fluminensis extracts and their isolated compounds against Dysdercus peruvianus and Oncopeltus fasciatus

ABSTRACT The effects of the hexanic extracts of the fruits and flowers of Clusia fluminensis Planch. & Triana, Clusiaceae, as well as their main constituents, the triterpene lanosterol and the benzophenone clusianone, were evaluated on hemipterans Dysdercus peruvianus and Oncopeltus fasciatus. The topical treatments of insects with the hexanic extracts significantly affected the survival of O. fasciatus, but not that of D. peruvianus. Concomitantly, extracts delayed the development of both hemipterans. Moreover, isolated lanosterol significantly reduced both the survival and development of O. fasciatus and D. peruvianus, while clusianone only reduce the survival of D. peruvianus and marginally inhibited the development of both insects. The results show the specific activity of lanosterol and clusianone against the two evaluated insect species and indicate the potential of compounds derived from C. fluminensis for the development of specific biopesticides for the control of agricultural pests. Subsequent work will examine the mode of action of lanosterol and clusianone isolates from C. fluminensis.

Biología del Desarrollo Vascular: Mecanismos en Condiciones Físiológicas y Estrés Flujo / Biology of Vascular Development: Mechanisms in Physiological Conditions and Shear Stress

La vasculogénesis es controlada por una serie de mecanismos que se activan en función del tiempo y del espacio durante el desarrollo embrionario. Múltiples son las vías de señalización implicadas en las etapas del proceso vasculogénico, las que se inician con estímulos angiogénicos desde el mesodermo o desde el endodermo para dar origen a los angioblastos (células progenitoras endoteliales). Proteínas como el factor de crecimiento vascular endotelial (VEGF), factor de crecimiento fibroblastico 2 (FGF2), entre otras, constituyen factores claves en la inducción de este proceso. Posteriormente, los angioblastos deben migrar para dar origen a los vasos primitivos, proceso en el que participan factores atrayentes y repulsivos que orientarán la dirección de su migración. Adicionalmente, los mecanismos de diferenciación arterio-venosa, regulados por la vía de señalización Hedgegog, VEGF y Notch, son determinados antes del inicio de la circulación, lo que sugiere que el destino de la célula endotelial se encuentra genéticamente determinado. Por su parte, los procesos de remodelación y proliferación vascular post natal, son generados a través de la formación de nuevos vasos a partir de vasos pre existentes (angiogénesis). El factor angiogénico que induce los cambios morfológicos y funcionales en las células endoteliales es el VEGFA, las cuales, adquieren la capacidad de direccionar al nuevo vaso en desarrollo. Uno de los principales estímulos físicos que modifica el patrón de crecimiento de los lechos vasculares es el estrés de flujo, el cual, es susceptible de ser modificado por situaciones de estrés como el ejercicio físico. En la presente revisión, se abordan los principales mecanismos implicados en la regulación fisiológica de la vasculogénesis y angiogénesis. Adicionalmente, se discutirán los mecanismos que sustentan la respuesta vascular inducida por estrés de flujo, considerando su rol en el establecimiento de los patrones de crecimiento vascular.

Vasculogenesis is controlled by a number of mechanisms that are activated as a function of time and space during embryonic development. Multiple signaling pathways are involved in the stages of vasculogenic process, which start with angiogenic stimuli from the mesoderm or the endoderm to give rise to angioblasts (endothelial progenitor cells). Proteins such as vascular endothelial growth factor (VEGF), fibroblast growth factor 2 (FGF2), among others, are key factors in the induction of this process. Subsequently, the angioblasts must migrate to give birth to primitive vessels, a process that involves attractive and repulsive factors that guide the direction of their migration. Additionally, arterial and venous differentiation regulated hedgegog signaling pathway, VEGF and Notch are determined before the start of circulation, suggesting that the endothelial cell fate is determined genetically. On the other hand, the processes of remodeling and postnatal vascular proliferation are generated through the formation of new vessels from pre-existing vessels (angiogenesis). The angiogenic factor that induces morphological and functional changes in the endothelial cells is the VEGFA, these vessels acquire the ability to address the new developing vessel. One of the main physical stimuli that modify the growth pattern of the vascular beds is the shear stress, which is modified by exercise. In this review, the main mechanisms involved in the physiological regulation of vasculogenesis and angiogenesis are addressed. Additionally, the mechanisms underlying the vascular response induced by shear stress will be discussed, considering its role in establishing patterns of vascular growth.

Biocontrol evaluation of extracts and a major component, clusianone, from Clusia fluminensisPlanch. & Triana againstAedes aegypti

Studies evaluated the effects of hexanic extracts from the fruits and flowers ofClusia fluminensis and the main component of the flower extract, a purified benzophenone (clusianone), against Aedes aegypti. The treatment of larvae with the crude fruit or flower extracts from C. fluminensis did not affect the survival ofAe. aegypti (50 mg/L), however, the flower extracts significantly delayed development of Ae. aegypti. In contrast, the clusianone (50 mg/L) isolate from the flower extract, representing 54.85% of this sample composition, showed a highly significant inhibition of survival, killing 93.3% of the larvae and completely blocking development of Ae. aegypti. The results showed, for the first time, high activity of clusianone against Ae. aegypti that both killed and inhibited mosquito development. Therefore, clusianone has potential for development as a biopesticide for controlling insect vectors of tropical diseases. Future work will elucidate the mode of action of clusianone isolated from C. fluminensis.

Effects of essential oil from leaves of Eugenia sulcata on the development of agricultural pest insects

Essential oils are known for their insect control potential, which is mainly attributed to the presence of terpenes that interfere with hormonal and physiological processes of arthropods. The aim of the present study was to evaluate the effects of essential oil from the leaves of Eugenia sulcata Spring ex Mart., Myrtaceae, on the development of two species of agricultural pest insects, Dysdercus peruvianus and Oncopeltus fasciatus. Results showed that the essential oil induced mortality, and reduced numbers of adults. Topical treatment of Oncopeltus fasciatus using pure essential oil caused significant mortality rates (96.67%), while Dysdercus peruvianus had a higher tolerance, with 80% mortality at the end of the experiments. Results suggest that essential oil from the leaves of Eugenia sulcata may be used in agriculture for insect pest control.

Laboratory evaluation of the effects of essential oil of Myrciaria floribunda leaves on the development of Dysdercus peruvianus and Oncopeltus fasciatus

Myrciaria floribunda (H. West ex Willd.) O. Berg, Myrtaceae, is popularly known as "camboim-amarelo" and was collected at Restinga de Jurubatiba (RJ, Brazil). Leaves from this species were submitted to hydrodistillation to extract its essential oil. Monoterpenes were the main compounds found (53.9%), and 1,8-cineole was the major constituent (38.4%). Studies were carried out to evaluate the effects of this essential oil on the development of two species of agricultural pests (Oncopeltus fasciatus and Dysdercus peruvianus). The essential oil was considered effective against D. peruvianus and O. fasciatus, causing mortality in both insects. The LD50 values (µg/insect) observed were 112.44 µg/insect (O. fasciatus) and 309.64 µg/insect (D. peruvianus) after one day of treatment, and 72.18 µg/insect (O. fasciatus) and 94.42 µg/insect (D. peruvianus) after 22 days of treatment. The present study reports for the first time the bioinsecticidal activity of essential oil of Myrciaria floribunda leaves, and provides important data regarding the use of essential oils in complementary programs for pest control.

Effects of the essential oil obtained from Pilocarpus spicatus Saint-Hilaire (Rutaceae) on the development of Rhodnius prolixus nymphae

Bioassays against fifth-instar nymphae of Rhodnius prolixus were conducted with essential oil of Pilocarpus spicatus extracted by hydrodistillation. The main results may be summarized as follows: (i) high levels of toxicity and paralysis together with discrete moulting inhibition were caused by topical application of either 0.5 µL or 1.0 µL per insect of the crude essential oil; (ii) partial fagoinhibition, high moulting inhibition, prolonged intermoulting period and high number of paralyzed insects, but no toxicity were observed after oral treatment using either 5 µL or 10 µL of Pilocarpus spilcatus essential oil per mL of ingested blood meal. The importance of these results in relation to the relevant biological events in R. prolixus is herein discussed.

Bioensaios contra ninfas de 5º estádio de Rhodnius prolixus foram conduzidos utilizando-se óleo essencial de Pilocarpus spicatus extraído por hidrodestilação. Os principais resultados podem ser resumidos como se segue: (i) altos níveis de toxicidade e paralisia associados à discreta inibição da muda foram induzidos pela aplicação tópica de 0,5 µL ou 1,0 µL do óleo essencial por inseto; (ii) fagoinibição parcial, altos níveis de inibição da muda, período intermuda prolongado e alto número de insetos paralisados mas ausência de toxicidade foram observados após tratamento oral com 5,0 µL ou 10 µL de óleo essencial de P. spicatus por mL de sangue ingerido. A importância destes resultados em relação a eventos biológicos relevantes em R. prolixus é aqui discutida.

Gametogenesis and nucleotypic effects in the tetraploid red vizcacha rat, Tympanoctomys barrerae (Rodentia, Octodontidae)

Nucleotypic effects link DNA content with nuclear size and cell dimensions of reproductive cells in polyploid organisms. We studied the gametogenesis of the allotetraploid rodent Tympanoctomys barrerae, aiming to determine these effects in reproductive cells. The species' cofamily members, Octodon degus and Spalacopus cyanus were used as control. Spermatogenesis and oogenesis in T. barrerae follows the pattern of differentiation and sequence of events of the control species, but varied nucleotypic effects were observed. Exceedingly large, spatulated spermatozoa with a submedially attached flagellum are characteristic of male T. barrerae. The diameter of the nuclei of primordial and growing follicles as well as those of the Graaff follicles, of the granulose, and of luteal cells are significantly larger and heavily heterochromatic. Moreover, the width of the pellucid zone is 108 percent thicker in T. barrerae than in S. cyanus. Binucleation was recorded in 26 percent of luteal bodies examined whereas no binucleated cells are detected in the diploid control. Likewise, large heterochromatic nucleoli were observed in the follicle cells but not in S. cyanus. This finding and the high heterochromatin content of reproductive cells in the red vizcacha rat is probably associated with its genome complexity so that redundant genetic information is silenced through heterochromatinization.

A multidisciplinary approach to the study of the fluminense vegetation

The fluminense vegetation, more specifically the flora from the Jurubatiba restinga has been investigated by a multidisciplinary team of botanists, chemist, radiobiologist, insect physiologists and geneticist. Vouchers of 564 specimens have been collected, identified, organized in an herbarium, and a database is being build up containing, in addition to classical botanical data, chemical data and information on the potential economic use either for landscape gardening, alternative foods or as medicinal plants. Phytochemical studies of the Guttiferae, Clusia hilariana, yielded oleanolic acid and nemorosone. Their biological activities against the haematophagous insect Rhodnius prolixus vector of Chagas disease have been investigated. Finally, it has been observed that aquatic plants possessed high levels of the natural radionuclide polonium-210, which seems to be originated mainly from soil rather than from atmospheric supply

Primer caso de queratitis fúngica en Chile debido a alternaria alternata / Fungical keratitis by alternaria alternata, first report in Chile

Un caso de queratitis fúngica debido a alternaria alternata es reportado. Este es el primer caso informado en Chile. Hifas fúngicas fueron detectadas en el raspado corneal, y cultivos fueron positivos a este hongo. El paciente fue, presumiblemente, curado después de tratamiento con Anfotericina-B e Itraconazol. Queratitis causadas por hongos filamentosos, del tipo especies de Fusarium, Aspergillus, Acremonium y Curvularia, son relativamente frecuentes, usualmente inducidos por trauma del tipo vegetales, metales y lentes de contacto. Nosotros reportamos un caso de queratitis humana debido a Alternaria alternata, posterior a traumatismo por un vegetal

Factilidad, riesgo y conveniencia de la cirugía ambulatoria para la patología anorrectal / Factibility, risk and convenience of ambulatory surgery for anorectal pathology

Se analizan y discuten los resultados obtenidos mediante cirugía ambulatoria para el tratamiento de patología anorrectal. De un total de 230 casos tratados en forma electiva entre 1984 y 1989 se recuperaron 160 historias clínicas. En el 92%de los casos, se efectuó el tratamiento ambulatorio. Las complicaciones fueron menos del 2%, registrándose un solo caso(hemorroidectomía) en el que fue necesaria la internación y reintervención antes de las 24 horas. La mortalidad fue nula. No se registraron resultados adversos atinentes a la falta de internación. La aplicación de esta estrategia depende fundamentalmente de la convicción del grupo quirúrgico en cuanto a su utilidad, siempre que la patología y las condiciones propias del paciente lo permitan. Los resultados obtenidos, muestran que en nuestro medio, la cirugía anorrectal ambulatoria puede ser practicada con escaso riesgo y certifican su factibilidad y la convierten en una práctica aconsejable, demostrando su conveniencia frente a la finitud de los medios disponibles

Cirugía anorrectal: tratamiento ambulatorio vs. tratamiento con internación, estudio costo/beneficio / Anorectal surgery: ambulatory treatment vs. commitment treatment: cost-benefit study

Se comparan costos y beneficios de la cirugía anorrectal, efectuada de manera ambulatoria vs. la misma cirugía acompañada de internación. Se estudian ventajas, inconvenientes y resultados en una muestra compuesta por 160 pacientes. Se efectuó cirugía ambulatoria en 147 casos (91,8%), sin registrar complicaciones atinentes a la metodología terapéuticas. Las complicaciones fueron escasas y la morbilidad nula. La diferencia de costos entre ambas estrategias se observó en el rubro correspondiente a internación. El análisis costo/beneficio, demuestra que para patología anorrectal, la cirugía ambulatoria efectuada con indicaciones precisas, es una estrategia efectiva y eficiente, con efectos positivos sobre el paciente, el médico y el sistema de atención que lo práctica en relación con el tratamiento con internación