Inter-laboratory ring trial to evaluate real-time reverse transcription polymerase chain reaction methods used for detection of infectious pancreatic necrosis virus in Chile

Background: Infectious Pancreatic Necrosis Virus (IPNV) is the etiological agent of a highly contagious disease that affects salmonids. In Chile, the second worldwide salmon producer, IPNV causes great economic loss and is one of the most frequently detected pathogens. Due to its high level of persistence and the lack of information about the efficiency of its diagnostic techniques, the National Reference Laboratory (NRL) for IPNV in Chile performed the first inter-laboratory ring trial, to evaluate the sensitivity, specificity and repeatability of the qRT-PCR detection methods used in the country. Results: Results showed 100% in sensitivity and specificity in most of the laboratories. Only three of the twelve participant laboratories presented problems in sensitivity and one in specificity. Problems in specificity (false positives) were most likely caused by cross contamination of the samples, while errors in sensitivity (false negatives) were due to detection problems of the least concentrated viral sample. Regarding repeatability, many of the laboratories presented great dispersion of the results (Ct values) for replicate samples over the three days of the trial. Moreover, large differences in the Ct values for each sample were detected among all the laboratories. Conclusions: Overall, the ring trial showed high values of sensitivity and specificity, with some problems of repeatability and inter-laboratory variability. This last issue needs to be addressed in order to allow harmonized diagnostic of IPNV within the country. We recommend the use of the NRL methods as validated and reliable qRT-PCR protocols for the detection of IPNV.

Empleo de la presión negativa en el tratamiento de heridas complicadas: Reporte de seis casos / Use of negative pressure for the treatment of complicated wounds: Report of six cases

Objetivo: Conocer la utilidad de un sistema de terapia basado en presión negativa tópica, aplicado en la herida quirúrgica complicada. Sede: Servicio de Cirugía General, hospital de tercer nivel de atención. Diseño: Estudio piloto, prospectivo, longitudinal y descriptivo. Análisis estadístico: Medidas de tendencia central. Pacientes y métodos: Se presentan seis pacientes postoperados, con herida quirúrgica abierta, complicada. Todos con infección demostrada por cultivo y con salida de material purulento, tres pacientes con abdomen abierto por sepsis abdominal, uno con lesión torácica postraumática, uno con muñón de amputación supracondílea infectado y el último paciente con herida quirúrgica complicada posterior a dermolipectomía; todos ellos con tratamientos previos sobre la herida quirúrgica antes de aplicar la presión negativa. Se incluyeron pacientes consecutivos que presentaban: herida complicada, infectada, con estancia hospitalaria prolongada, quienes no presentaban progreso con el tratamiento médico tradicional. Resultados: El tiempo de aplicación de la presión negativa para los seis pacientes estuvo entre 6 y 26 días, con evolución satisfactoria, obteniéndose la mejoría deseada de la herida quirúrgica y de la cavidad abdominal. En los tres pacientes con abdomen abierto y tratamiento previo con bolsa de Bogotá, se pudo cerrar la cavidad abdominal entre los 14 y los 26 días posteriores al tratamiento con presión negativa; en los otros tres pacientes, con lesiones más superficiales, el cierre de la herida se logró entre el sexto y el décimo cuarto día. En todos hubo seguimiento mayor a cinco meses, conservándose la herida cerrada, sin alteraciones. Conclusión: La terapia de presión negativa fue útil en el tratamiento de pacientes con heridas quirúrgicas complicadas y/o en el tratamiento de pacientes con abdomen abierto en sustitución de la bolsa de Bogotá. Del 100% de días de estancia hospitalaria, el 30% fue con terapia basado en presión negativa tópica.

Objective: To know the usefulness of a therapy system based on negative pressure topically applied on a complicated surgical wound. Setting: General Surgery Service, third level health care hospital. Design: Pilot study, prospective, longitudinal and descriptive. Statistical analysis: Central tendency measures. Patients and methods: We present six post-operated patients with open complicated surgical wounds. All with infection demonstrated by culture and output of purulent material: three patients with open abdomen due to abdominal sepsis, one with post-traumatic thoracic injury, one with an supracondyle infected stump, and the last with complicated surgical wound due to dermolipectomy, all of them with treatments of the surgical wound before applying negative pressure. We included consecutive patients coursing with complicated infected wounds, prolonged in-hospital stay, and who did not improve with traditional medical treatment. Results: The time of negative pressure application for the six patients ranged from 6 to 26 days, with satisfactory evolution, obtaining the expected improvement of the surgical wound and the abdominal cavity. In the three patients with open abdomen and previous treatment with Bogota pouch, the abdominal cavity could be closed between 14 and 26 days of negative pressure treatment; in the other three patients with more superficial wounds, closure of the wound was achieved between the 6th and 14th day. All patients were followed for more than 5 months, the wound remained closed and without any alterations. Conclusion: Negative pressure therapy was useful in the treatment of patients with complicated surgical wounds and/or treatment of open abdomen substituting the Bogota pouch. Of the 100% of in-hospital stay days, 30% corresponded to topically applied negative pressure therapy.

Poliposis adenomatosa familiar: presentación de dos casos en gemelos masculinos idénticos / Familial adenomatous polyposis: case report of male twins

BACKGROUND: One hundred percent of the cases of familial adenomatous polyposis (FAP) will develop carcinoma; therefore, the necessity of diagnosis at an early age with immediate therapy is essential. In the presence of identical twins, it is mandatory for both to undergo comprehensive colonic examination as early as possible. The study took place at a third-level general hospital with the objective of explaining in detail the importance of early diagnosis of FAP. CLINICAL CASES: We report on FAP in identical male twins who were operated on at different times with different outcomes and prognosis. The first twin was treated 20 years previously at an early age and underwent subtotal colectomy with ileoproctostomy. This patient is currently asymptomatic with no evidence of malignancy. The second twin was operated on at the age of 33 years and was already a carrier of a well differentiated rectal adenocarcinoma. CONCLUSIONS: Opportune therapy carried out on the first twin has resulted in a disease-free status, in contrast with the delay in treatment of the second twin who developed carcinoma.

Propuesta de una escala práctica para el diagnóstico temprano de apendicitis aguda / Proposal of a practical scale for the early diagnosis of acute appendicitis

Objetivo. Propuesta de una escala práctica, confiable y dinámica para el diagnóstico temprano de apendicitis aguda. Diseño. Estudio longitudinal, prospectivo. Sede. Servicio de Urgencias Médico Quirúrgicas. Hospital de tercer nivel de atención. Pacientes y Método. Se evaluaron 281 casos con dolor abdominal agudo de julio de 1995 a junio de 1996. Ciento cincuenta y seis hombres y 125 mujeres, con edad promedio de 28.4 años. Doscientos treinta presentaron apendicitis con confirmación histopatológica. Análisis estadístico. Prueba F y T. Resultados. Se realizó una escala para el diagnóstico temprano de la pendicitis aguda, basada en 3 signos (dolor a la palpación en cuadrante inferior derecho, rebote en fosa iliaca derecha, McBurney), 3 síntomas (dolor migratorio a fosa iliaca derecha, anorexia, náusea/vómito) y 2 hallazgos de laboratorio (leucocitosis < 10,000 células/mm3, neutrofilia < 7,500 células/mm3) a cada uno de los cuales se les asignó un valor para un total de 10 puntos. Siete puntos o más se consideró como candidato a cirugía por probable apendicitis. Los puntos promedio con la escala en pacientes con apendicitis fue de 8.9 y de 7.1 sin la enfermedad. Existen diferencias estadísticamente significativas (p<0.05) entre los pacientes con y sin apendicitis. Conclusión. La escala propuesta demostró ser útil en el diagnóstico temprano de la apendicitis aguda, puede ser de ayuda cuando exista discrepancia en el tratamiento oportuno