[Evaluation of an instrument assessing the satisfaction of ophthalmological emergency service users in Chile]. / Satisfacción usuaria en urgencia oftalmológica: evaluación de la consistencia interna y validez de constructo de un instrumento aplicado en Chile.

BACKGROUND: Ocular trauma is a distressing condition feared by the general public. AIM: To evaluate the construct validity and internal consistency of an instrument to measure the level of user satisfaction in patients treated at an Ocular Trauma and Ophthalmological Emergency Unit. MATERIAL AND METHODS: A survey to measure user satisfaction was applied to patients consulting at the Ocular Trauma Unit in a public hospital on April 2014. Internal consistency and construct validity from the estimated Cronbach alpha coefficient and factor analysis were assessed. RESULTS: Surveys answered by 138 patients aged 45 ± 15 years (93% men), were analyzed. The reliability obtained for the final questionnaire was 0.88. The factor analysis yielded four factors responsible for explaining 74.1% of the total variance, related to "quality of clinical information", "treatment by health care personnel", "lighting conditions, environment and noise" and "waiting time and overall assessment of service". CONCLUSIONS: These results allow to consider the instrument as a useful and reliable tool that can be applied to ophthalmological emergency service users in Chile.

Bicarbonate enhances the in vitro antibiotic activity of kanamycin in Escherichia coli.

UNLABELLED: Growth of enteropathogenic Escherichia coli E2348/69 was inhibited by bicarbonate in a dose-dependent manner, showing approximately 5% growth reduction at 5 mmol l(-1) while kanamycin at 3·12 µg ml(-1) inhibited growth by 15%, yet when kanamycin and bicarbonate were combined at these concentrations, inhibition increased to 80%. Unexpectedly, at bicarbonate concentrations >20 mmol l(-1) enhancement of the antibiotic activity virtually disappeared, i.e. there was a paradoxical Eagle-like effect. How bicarbonate acts is unclear, but neutral or alkaline pH also enhanced the activity of kanamycin. However, several differences indicated a separate effect of bicarbonate. First, bicarbonate inhibited growth more than the corresponding increments in pH. Second, at low concentration, the antibiotic enhancing effect of bicarbonate was stronger than the effect of pH alone. Third, 5 mmol l(-1) bicarbonate significantly enhanced the activity of kanamycin while the corresponding pH had no effect. Fourth, the Eagle-like effect was exclusive of bicarbonate because changes in pH did not induce an analogous behaviour. Notwithstanding the mechanism, the enhancing effect of bicarbonate was indubitable. Consequently, it seems worthwhile to explore further its potential to improve the efficacy of aminoglycosides and maybe even other antibiotics. SIGNIFICANCE AND IMPACT OF THE STUDY: Bicarbonate at a low concentration enhanced the in vitro antibiotic activity of kanamycin and gentamicin. Even though the action mechanism of bicarbonate is hitherto unknown, it seems worthwhile to explore further its capacity to improve the efficacy of aminoglycosides. Clearly, the well-known harmful side-effects of aminoglycosides are a concern. However, it has recently been shown in a fish model that bicarbonate may protect ciliary cells against the damage caused by aminoglycosides. So, it seems possible that bicarbonate could help reduce aminoglycoside dosage at the same time that it might help lessen the damage to auditory ciliary cells in humans.

Work-related asthma: diagnosis and prognosis of immunological occupational asthma and work-exacerbated asthma.

The incidence and prevalence of asthma are increasing. One reason for this trend is the rise in adult-onset asthma, especially occupational asthma, which is 1 of the 2 forms of work-related asthma. Occupational asthma is defined as asthma caused by agents that are present exclusively in the workplace. The presence of pre-existing asthma does not rule out the possibility of developing occupational asthma. A distinction has traditionally been made between immunological occupational asthma (whether IgE-mediated or not) and nonimmunological occupational asthma caused by irritants, the most characteristic example of which is reactive airway dysfunction syndrome. The other form of work-related asthma is known as work-exacerbated asthma, which affects persons with pre-existing or concurrent asthma that is worsened by work-related factors. It is important to differentiate between the 2 entities because their treatment, prognosis, and medical and social repercussions can differ widely. In this review, we discuss diagnostic methods, treatment, and avoidance/nonavoidance of the antigen in immunological occupational asthma and work-exacerbated asthma. Key words: Specific inhalation challenge. Peak expiratory flow. Workplace. Irritants.

Diesel exhausts particles: Their role in increasing the incidence of asthma. Reviewing the evidence of a causal link.

Exposure to air pollutants has been correlated with an increase in the severity of asthma and in the exacerbation of pre-existing asthma. However, whether or not environmental pollution can cause asthma remains a controversial issue. The present review analyzes the current scientific evidence of the possible causal link between diesel exhaust particles (DEP), the solid fraction of the complex mixture of diesel exhaust, and asthma. The mechanisms that influence the expression and development of asthma are complex. In children prolonged exposure to pollutants such as DEPs may increase asthma prevalence. In adults, this causal relation is less clear, probably because of the heterogeneity of the studies carried out. There is also evidence of physiological mechanisms by which DEPs can cause asthma. The most frequently described interactions between cellular responses and DEP are the induction of pulmonary oxidative stress and inflammation and the activation of receptors of the bronchial epithelium such as toll-like receptors or increases in Th2 and Th17 cytokines, which generally orchestrate the asthmatic response. Others support indirect mechanisms through epigenetic changes, pulmonary microbiome modifications, or the interaction of DEP with environmental antigens to enhance their activity. However, in spite of this evidence, more studies are needed to assess the harmful effects of pollution - not only in the short term in the form of increases in the rate of exacerbations, but in the medium and long term as well, as a possible trigger of the disease.

Assessment of dyspnea and dynamic hyperinflation in male patients with chronic obstructive pulmonary disease during a six minute walk test and an incremental treadmill cardiorespiratory exercise test.

The six minute walk test (6MWT) is a standardized test that provides information on exercise capacity in patients with COPD. It is considered a submaximal test in opposition to incremental cardiopulmonary exercise tests (CPET) that provide valuable information on all the systems involved in exercise. OBJECTIVES: 1. To compare the perceptive, physiological responses and degree of dynamic hyperinflation during two exercise tests: the 6MWT and the incremental CPET on a treadmill. 2. To evaluate how dyspnea is related to dynamic hyperinflation (DH) and other functional parameters in both tests. METHODS: 29 stable COPD male patients, age 68±5.8 years, mean post-bronchodilator FEV1 57±11%, were recruited. To evaluate dynamic hyperinflation, inspiratory capacity (IC) was measured at rest and upon completing each one of the tests. At the same time, perceived dyspnea and leg discomfort were rated on specific modified Borg scales. RESULTS: The mean walk distance in 6MWT was 494±88m. The Borg scale rating for shortness of breath upon completing the test was 4.7±2, whilst 2.9±2 for leg discomfort. IC changed from 2.53±0.63l before to 2.34±0.60l after completion of the test. In the treadmill CPET, maximal oxygen consumption (V˙O2max) was 21.8±5mL/kg/min with 6.6±2 dyspnea and 4.3±2 leg discomfort on Borg scales. IC changed from 2.17±0.53l to 1.20±0.43l. CONCLUSIONS: Dynamic hyperinflation occurs in male COPD patients during submaximal exercise such as the 6MWT. This phenomenon is more pronounced after incremental CPET on a treadmill. Despite being dyspnea the dominant limiting symptom for both tests, we observed different physiological responses.

The use of pupillometry as monitoring of intraoperative analgesia in the consumption of analgesics during the first 12 hours after surgery.

INTRODUCTION: Intraoperative evaluation of analgesia remains today often based on heart rate and arterial pressure fluctuations. None of these parameters is specific. Incorrect handling during this process may increase surgical morbi-mortality of the patients and their acute postoperative pain. The aim of this study was to evaluate the impact of intraoperative analgesia controlled by pupillometry on postoperative analgesic consumption and the pain intensity in the first 12h in the hospital room, after major gynecological surgery. PATIENTS AND METHODS: A prospective, cohort study with allocation of groups of sequentially according to programming of operating room was designed. ASA I-III patients scheduled for elective surgery of abdominal hysterectomy by laparotomy or laparoscopy through intravenous general anesthesia were included. Patients were divided into 2 groups: pupillometry group (P-1), in which intraoperative analgesia was guided by pupillometry, and hemodynamic group (H-2) according to values of blood pressure and heart rate. In the hospitalization room the values of visual analogue scale (VAS) were routinely registered with 3 courts for the study: 3, 8 and 12h of the postoperative period. Postoperative analgesia was standardized as follows: NSAIDs was administered if VAS was ≥ 3 or if the patient expressly requested an analgesic. After this, the efficacy of treatment was assessed. If the patient had pain, the next scheduled drug was given up to an VAS<3. Data for total analgesic consumption administered in the hospital room, VAS and adverse effects were collected within 12h postoperatively. RESULTS: A total of 59 patients, 30 group P-1 and 29 group H-2, were included. Group P-1 experienced less pain than group H-2, with statistical significance in each phase (VAS 3h, VAS 8h and VAS 12h). These data are consistent with the consumption of analgesics for patients. There was a statistically significant reduction (p<0.001) in the group P-1 (1.80 [DE 0.99]; medium 2, 95% confidence interval 1.43-2.17) compared with group H-2 (5.66 [1.58]; medium 6, 95% confidence interval 5.05-6.26). CONCLUSIONS: Monitoring of the intraoperative analgesia by pupillometry was able to reduce the intensity of the acute postoperative pain and analgesic consumption in the first 12h in the hospital room after major gynecological surgery.

Perfil de población con baja visión que asiste a la unidad de baja visión y rehabilitación visual en un hospital clínico de Chile / Low vision population assisting a unit of low vision and visual rehabilitation in a clinical hospital from Chile

El objetivo de este trabajo fue caracterizar epidemiológica y sociodemográficamente a las personas atendidas en la Unidad de Baja Visión y Rehabilitación Visual del Hospital Clínico de la Universidad de Chile. El método utilizado fue un estudio descriptivo, transversal y retrospectivo de los registros clínicos de las personas atendidas en la Unidad, entre marzo de 2015 a octubre de 2016. Para el análisis se utilizó el software MS Excel, calculando las frecuencias relativas y medidas de posición central y dispersión. En los resultados se observaron un mayor número de pacientes de sexo femenino (55,5%), y adultos mayores de 60 años o más (53,3%). El 73,3% de los pacientes pertenecieron al sistema de salud público y un 35,6% poseían menos de 8 años de estudio. El 80 % de las personas atendidas se encuentra en edad laboral, de éstos un 63,9% se encontraban laboralmente inactivos. Las enfermedades oftalmológicas con mayor frecuencia correspondieron a las enfermedades genéticas del ojo (22,2%) y la degeneración macular relacionada con la edad (17,8%). Un 57,8% de los pacientes presentó alguna patología sistémica asociada a baja visión. Sólo un 6,0% recibió rehabilitación visual anteriormente. Se concluyó que la mayor prevalencia de enfermedades oculares asociadas al envejecimiento como la degeneración macular relacionada con la edad y enfermedades genéticas del ojo, sumado a las características sociodemográficas y en particular a que un 94% de los pacientes no habían tenido acceso a rehabilitación visual, constituyen un perfil que desafía al desarrollo de medidas de salud pública que resguarden la prevención, acceso y rehabilitación, siendo la formación de equipos multidisciplinarios especialistas una necesidad imperiosa.

This work aimed to do a characterization, epidemiological and socio demographical, to the people attended in a Low Vision and Rehabilitation Unit from a Clinical Hospital of the Universidad de Chile. A descriptive, transversal and retrospective method was used for the clinical registers of the people attended in the Unit, between March 2015 to October 2016. For the analysis, a MS Excel software was used, calculating the relative and measured frequencies of central position and dispersion. In the results, a greater number of feminine patients (55. 5%) were observed, and seniors of 60 years or more (53.3%). 73.3% of the patients belonging to the Public Health Care System and 35.6% had less than 8 years of studies. The 80% of attended patients were in working age, from this 63,9% were unemployed. The ophthalmological diseases with more frequency belonged to eye genetic diseases (22.2%) and macular degeneration related to age (17.8%). 57.8% of the patients presented a systematic pathology associated with low vision. Just 6.0% received previous visual rehabilitation. We concluded that the greater prevalence of ocular diseases associated to aging such as macular degeneration related to age and eye genetic diseases added to the sociodemographic features and particularly a 94% of the patients did not have access to visual rehabilitation, represent a profile that challenges the development public health care measures that safeguard the prevention, access, and rehabilitation, being an imperative need the making of specialist multidisciplinary teams.

Ocular trauma score como predictor de agudeza visual en pacientes con trauma ocular grave: predictor de pronóstico visual en urgencia oftalmológica / Ocular trauma score as a predictor of visual acuity in patients with severe ocular trauma: visual prognosis in ophthalmological urgency

El objetivo de este trabajo fue determinar la relación entre el pronóstico visual según el Ocular Trauma Score (OTS) y la agudeza visual (AV) a los 6 meses de ocurrido el trauma ocular, en pacientes atendidos en la Unidad de Trauma Ocular del Hospital del Salvador, Santiago de Chile. Se hizo uso de un estudio descriptivo, longitudinal, retrospectivo. Se accedió a los registros clínicos de pacientes atendidos por trauma ocular grave entre el 1 de enero de 2014 al 15 de marzo 2015. 145 pacientes conformaron una muestra de 153 ojos. Se estableció la relación entre OTS obtenido y la AV a 6 meses del trauma mediante el coeficiente de correlación de Spearman. De los ojos estudiados, el grupo mayor N=68 (44,4%) calificó para OTS 3 y el menor N=16 (10,5%) para OTS 1. Se presentaron cinco categorías de visión, en un tiempo inicial la mayoría de los casos presentaron AV de luz, mala proyección-cuenta dedos (n=89). Tras seis meses dicha distribución se desplazó hacia la categoría 20/40 - 20/20 (n=68). Se encontró una fuerte asociación (r=0,711 p=0,000) entre el OTS calculado y la AV luego de seis meses de seguimiento. El OTS demostró poseer un gran valor predictivo y es una herramienta aplicable en nuestro medio, los datos obtenidos indican que existe un mejor pronóstico visual que los obtenidos en otro estudio. Cabe destacar que es la primera instancia en que se evalúa la aplicación del OTS en Chile.

This work aimed to determine the relationship between the visual prognosis according to the Ocular Trauma Score (OTS) and visual acuity (AV) 6 months after the ocular trauma in patients treated at the Eye Trauma Unit from the Hospital del Salvador, in Santiago, Chile. A descriptive, longitudinal and retrospective study was performed. We accessed registers of clinical patients attended for severe eye trauma from 1 January 2014 to 15 March 2015. 145 patients constitute a sample of 153 eyes. A connection was established between the OTS obtained and the AV 6 months after the trauma via the Spearman correlation coefficient. From the eyes studied, the greatest group N=68 (44.4%) qualified for OTS 3 and the smallest N=16 (10.5%) for OTS 1. Five eye categories were presented, in the beginning, most of the cases presented visual acuity with bad projection ­ hand motion (n=89). After six months of distribution, it moved to the category 20/40 ­ 20/20 (n=68). A strong relation (r=0,711 p=0,000) was found between the estimated OTS and the AV after six months of tracking. The OTS proved to have great predictive valor and is an applicable tool in our area, the data obtained showed that there is a better visual prognosis than the obtained in other studies. It is worth noting that this is the first stage where the application of OTS is assessed in Chile.

Identification of Campylobacter jejuni and C. coli using the rpoB gene and a cryptic DNA fragment from C. jejuni.

Campylobacter jejuni (Cj) and C. coli (Cc) clinical isolates, obtained from three different sources, were characterized using two Cj DNA probes, CJ01 and CJ02. These probes were selected at random by virtue of their stability in Escherichia coli (Ec). CJ01 hybridized specifically with DNA from Cj reference strains, but not with DNA from Cc, C. lari (Cl) nor C. fetus (Cf) reference strains. Using clinical isolates characterized by genome-genome hybridization and biotype, CJ01 hybridized with DNA derived from all Cj strains. However, DNA from four out of ten Cc strains, from three different sources, also hybridized with CJ01, suggestive of this region being heterogeneous between clinical isolates of both species. The nucleotide sequence analysis of CJ01 reveals two incomplete open reading frames (ORFs) that did not show significant homology with any other known sequences. CJ02 hybridized specifically with DNA from Cj and Cc reference strains, but not with DNA from Cl and Cf reference strains. The specificity and sensitivity were maintained upon hybridization with DNA from 31 clinical isolates. CJ02 has an uninterrupted ORF whose deduced amino-acid sequence showed extensive homology with the central region of the Ec and Salmonella typhimurium (St) RNA polymerase beta subunits (52 and 66% similarity, respectively). The most conserved segments correspond to putative functional domains.

Calcified neurocysticercotic lesions and postsurgery seizure control in temporal lobe epilepsy.

BACKGROUND: Several studies suggest that neurocysticercosis is the main cause of symptomatic epilepsy in developing countries. In such areas, calcified cysticercotic lesions (CCL) are frequently found in patients with complex partial seizures associated with hippocampal sclerosis (HS). The authors studied whether there are clinical and pathologic differences between HS patients with and without CCL. METHODS: The authors determined the clinical and pathologic findings of 30 patients with HS and compared them with 32 patients with HS + CCL. Hippocampi from both groups were measured for fascia dentata Timm staining and cell density in hippocampal subfields. RESULTS: In the HS + CCL group, single or multiple CCL were found in all lobes with no lobar predominance. An initial precipitating event occurred in 83.3% of HS and in 62.5% of HS + CCL. First complex partial seizure occurred at 10.1 years in HS and at 11.9 years in HS + CCL. No significant differences were found for fascia dentata Timm staining and hippocampal cell densities. Good postsurgery outcome (Engel I classification) did not differ between groups, with this result occurring in 76.6% of patients with HS and 81.2% of patients with HS + CCL. CONCLUSIONS: The presence of CCL does not influence the clinical and pathologic profile of patients with hippocampal atrophy. Clinical histories and postsurgical outcomes were similar to those of patients with classic HS, suggesting that the CCL is probably, in this set of patients, a coincidental pathology and does not have a role in epileptogenesis.

Accuracy of ictal SPECT in mesial temporal lobe epilepsy with bilateral interictal spikes.

OBJECTIVE: In mesial temporal lobe epilepsy (MTLE), the rate of correct seizure lateralization of ictal semiology and ictal EEG is better for patients with unilateral interictal spikes (UIS) than for patients with bilateral interictal spikes (BIS), possibly due to rapid seizure propagation patterns associated with bilateral epileptogenesis. In this study, the authors investigated if ictal SPECT is a reliable diagnostic test for both UIS and BIS patients. METHODS: Video-EEG recording was used as the gold standard to examine the accuracy of ictal SPECT and its relationship with interictal and ictal EEG. Ninety-three consecutive patients with MTLE associated with hippocampal sclerosis were included in the analysis. Ictal SPECT was considered accurate if two blinded observers independently lateralized the scan correctly. RESULTS: Ictal SPECT correctly lateralized 75 (80.6%) of 93 scans. The rate of correct seizure lateralization was 87.6% for the UIS group and only 55.0% for the BIS group (p = 0.0027). In the EEG epochs, 66.7% of BIS patients vs 43.4% of UIS patients had nonlateralized ictal EEG (p < 0.001). CONCLUSION: The authors conclude that the accuracy of ictal SPECT is worse for MTLE patients with BIS than for those with UIS. The role of ictal SPECT in presurgical evaluation of patients with BIS must be reviewed.

[Comparison of mouth pressure, twitch, after anterior magnetic stimulation against posterior magnetic stimulation in healthy subjects]. / Comparación de la presión en boca, twitch, tras estimulación magnética anterior frente a estimulación magnética posterior en sujetos sanos.

BACKGROUND: If techniques for studying respiratory muscle function are easy to use and well tolerates by patients, they can be used routinely. Measuring mouth twitches (TwM) using either bilateral anterior or posterior magnetic stimulation meets both criteria. SUBJECTS AND METHODS: We studied 16 healthy subjects. TwM was measured using bilateral anterior (TwMA) and posterior (TwMP) stimulation. Ten stimuli were applied for each technique for each subject. Five subjects repeated the test was repeated on a different day. RESULTS: The mean TwMA in healthy subjects was 21.07 +/- 4.4 cmH2O (range 13.72-30.11); the mean TwMP was 21.12 +/- 5.9 cmH2O (range 12.7-35.7) (NS). The mean difference was 2.8 +/- 2.5 cmH2O, while the ratio TwMP/PImax was 0.15 (range 0.08-0.10) and TwMA/PImax was 0.14 (range 0.07-0.15). The correlation between the two technique was 0.8. The patients who underwent testing twice had a mean TwMA of 20 cmH2O on the first day and 10.18 cmH2O on the second (NS). The coefficient of variation (CoV%) was 5.9% for TwMA and 7.2% for TwMP. CONCLUSIONS: The two techniques for measuring TwM give similar results and coefficients of variation in healthy subjects; either technique can be used. Variation from one testing day to another is low.

Autopercepción de conocimientos y competencias de profesores en la prevención de conductas suicidas adolescentes pre y posintervención / Self-perceived knowledge and skills of teachers for prevention of suicidal behavior in adolescents pre and post-intervention

Resumen Introducción: El suicidio es la segunda causa mundial de mortalidad en personas de 15 a 29 años, por ende, su prevención es fundamental. En Chile no existen programas implementados en colegios para capacitar a profesores en la prevención de estas conductas. Se diseñó una capacitación orientada a profesores para conocer si esta estrategia es efectiva en mejorar la autopercepción de competencias al enfrentarse a estas situaciones. Método: Diseño cuantitativo cuasi experimental de series cronológicas. Se realizó un cuestionario a 27 profesores de un colegio de San Felipe, Chile, antes y después de 3 meses de la intervención. Se evaluaron sus experiencias, conocimientos y competencias sobre prevención de conductas suicidas. Resultados: No hubo diferencias significativas en la evaluación de conocimientos. Sin embargo, hubo un cambio significativo (p < 0,05) en la autopercepción de competencias en 6 aspectos. Aumentó la confianza y sensación de comodidad para responder a estos jóvenes, la percepción de que el suicidio juvenil es prioridad y requiere de ayuda especializada, sensación de contar con más herramientas y conocimientos de los recursos de su comunidad. No obstante, la sensación de responsabilidad en el manejo de estos adolescentes tuvo un cambio negativo. Conclusiones: La capacitación estudiada que entrega conocimientos y estrategias sobre suicidalidad en adolescentes, a profesores, produce cambios significativos en la autopercepción de competencias, pero no permite establecer una tendencia al cambio. Se hace necesario contar con otros estudios.

Introduction: Suicide is the second leading cause of death among people aged 15-29 years, therefore, prevention is essential. There are no programs implemented in chilean's schools to train teachers in the prevention of these behaviors. A training was designed to teachers to know if this strategy is effective in the improvement of the self-perception of competencies when facing these situations. Method: Quantitative quasi-experimental, interrupted time-series design. A questionnaire was carried out on 27 teachers from a school in San Felipe, Chile, before and after 3 months of the intervention. Their experiences, knowledge and competences on prevention of suicidal behavior were evaluated. Results: There were no significant differences in the assessment of knowledge. However, there was a significant (p < 0.05) change in self-perception of competencies in 6 items. Increased confidence and comfort in responding to these young people, the perception that juvenile suicide is a priority and requires specialized help, the feeling of having more tools and knowledge of the resources of their community. However, the sense of responsibility in the management of these adolescents had a negative change. Conclusions: The training studied that provides knowledge and strategies on adolescents' suicidal behaviors to teachers produces significant changes in self-perception of competencies, but it does not allow to establish a tendency to change. It is necessary to have other studies.

Satisfacción usuaria en urgencia oftalmológica: evaluación de la consistencia interna y validez de constructo de un instrumento aplicado en Chile / Evaluation of an instrument assessing the satisfaction of ophthalmological emergency service users in Chile

Background: Ocular trauma is a distressing condition feared by the general public. Aim: To evaluate the construct validity and internal consistency of an instrument to measure the level of user satisfaction in patients treated at an Ocular Trauma and Ophthalmological Emergency Unit. Material and Methods: A survey to measure user satisfaction was applied to patients consulting at the Ocular Trauma Unit in a public hospital on April 2014. Internal consistency and construct validity from the estimated Cronbach alpha coefficient and factor analysis were assessed. Results: Surveys answered by 138 patients aged 45 ± 15 years (93% men), were analyzed. The reliability obtained for the final questionnaire was 0.88. The factor analysis yielded four factors responsible for explaining 74.1% of the total variance, related to “quality of clinical information”, “treatment by health care personnel”, “lighting conditions, environment and noise” and “waiting time and overall assessment of service”. Conclusions: These results allow to consider the instrument as a useful and reliable tool that can be applied to ophthalmological emergency service users in Chile.

Programas de prevención del suicidio adolescente en establecimientos escolares: una revisión de la literatura / Suicide prevention programs for adolescents in schools: a review

The suicide deaths increased worldwide and also in Chile in the last decade. Therefore, preventive programs are needed. This paper reviews the literature on school suicide prevention programs. Results show that few programs center in suicide as the primary target, and most do on related factors such as major depression. Nevertheless, some of them lower suicide ideation and behavior in the studied sample especially when they target several objectives and perform two or more interventions.

Las muertes por suicidio han aumentado a nivel mundial y especialmente en nuestro país en la última década. Por ello se hace necesario realizar un trabajo preventivo, principalmente en adolescentes. El presente trabajo tuvo como objetivo realizar una revisión de la literatura de los programas de prevención de suicidio en adolescentes escolares. Los resultados demostraron que son pocos los programas centrados en abordar el suicidio como objetivo principal sino que su foco son factores asociados, como por ejemplo la depresión mayor. Aún así, varios consiguen una disminución de la ideación y conducta suicida en la población estudiada, especialmente cuando implementan más de una intervención.

Inserción laparoscópica de catéter de diálisis peritoneal: experiencia de 3 años / Laparoscopic placement of peritoneal dialysis catheters: experience in 81 patients

Background: Laparoscopic placement of peritoneal dialysis catheters is associated with a lower rate of complications. Aim: To report the experience in laparoscopic placement of peritoneal dialysis catheters. Material and Methods: Review of medical records of 81 patients aged 15 to 90 years (42 males) subjected to the procedure between 2010 and 2013. Results: A three port plus omentopexy technique was used. Surgical time was 51 minutes. Other simultaneous surgical procedures were performed in four patients. No patient died, had a bowel perforation or required conversion to open surgery. Ninety eight percent of patients were discharged less than 24 hours after the procedure, using standard analgesics. Four patients required a new surgical procedure due to minor complications. All installed catheters were functional until the moment of his review. Conclusions: Laparoscopic placement of peritoneal dialysis catheters is a safe and effective procedure...

Objetivo: Describir la técnica quirúrgica usada en Hospital Regional de Talca (HRT) para la inserción laparoscópica de catéter de diálisis peritoneal y analizar sus resultados. Material y Método: Se realizó un estudio retrospectivo, descriptivo, mediante la revisión de fichas clínicas del total de pacientes sometidos a inserción laparoscópica de catéter de peritoneodiálisis en el HRT entre marzo de 2010 y abril de 2013. Se recopiló información sobre los pacientes, la técnica quirúrgica y complicaciones postoperatorias. Resultados: Total 81 pacientes, sin exclusiones, sometidos a cirugía bajo técnica laparoscópica de 3 puertos más omentopexia. Tiempo quirúrgico medio 50,9 min. Se realizó otro procedimiento quirúrgico simultáneo en 4 pacientes. No se reportaron perforación de víscera hueca ni conversión a cirugía abierta. No hubo mortalidad asociada al acto quirúrgico. El 97,5 por ciento tuvo alta quirúrgica antes de las 24 h postoperatorias, con requerimientos analgésicos estándar. Sólo 4 pacientes requirieron reintervención quirúrgica por complicaciones menores y en 4 se realizó laparoscopia diagnóstica tardía por dolor. El 100 por ciento de los catéteres instalados bajo esta técnica permanecen funcionales hasta el momento del corte de la serie. Conclusión: Nuestra experiencia es comparable con otras series a nivel mundial, siendo un procedimiento reproducible de manera segura y costo-efectiva...

Neuroethology application for the study of human temporal lobe epilepsy: from basic to applied sciences.

The aim of this investigation was to apply neuroethology to the study of human temporal lobe epilepsy (TLE). For this purpose, 42 seizures in 7 patients recorded during video/EEG monitoring (1997-1998) were analyzed by means of a behavioral glossary containing all behaviors. Video recordings were reobserved, and all patients' behaviors were annotated second-by-second. Data were analyzed using Ethomatic software and displayed as flowcharts including frequency, mean duration, and sequential statistic interaction of behavioral items (chi2 > or = 10.827, P<0.001). Flowcharts of (1) a group of seizures from a single patient, (2) the sum of four seizures per patient of two patients with right and five patients with left TLE, and (3) the comparison of left versus right TLE are shown. Well-established data in the literature were confirmed, such as aura (especially epigastric), contralateral lateralization value of dystonia and version, consciousness and language alterations in ictal and postictal periods, mostly with respect to dominant hemisphere involvement, among others. Less well established data such as awakening seizures in TLE patients, lateralization value of facial wiping (ipsilateral to the focus), statistically significant associations between behavioral pairs (dyads), and new behavioral sequences in TLE were also observed. We suggest that neuroethology also has great potential in the study of human epilepsy semiology. This work had an important role in method standardization for human epilepsy, setting the basis for the development of future clinical studies including correlation with other diagnostic methods (EEG, magnetic resonance, and SPECT). The next step will be the comparative study of seizures of patients with left and right TLE, with a greater number of patients, and the development of a digital video library.