Models of comprehensive care for older persons with chronic diseases: a systematic review with a focus on effectiveness.

INTRODUCTION: Ageing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective. METHODS: A systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups. RESULTS: Of the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective. CONCLUSIONS: It was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient-healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.

Effects of intensity, attention and medication on auditory-evoked potentials in patients with fibromyalgia.

Fibromyalgia (FM) has been associated to an increased processing of somatosensory stimuli, but its generalization to other sensory modalities is under discussion. To clarify this, we studied auditory event-related potentials (AEPs) to stimuli of different intensity in patients with FM and healthy controls (HCs), considering the effects of attention mechanisms and medication. We performed two experiments: In study 1 (n = 50 FM, 60 HCs), the stimuli were presented randomly within the sequence; in study 2 (n = 28 FM, 30 HCs), they were presented in blocks of the same intensity. We analyzed intensity and group effects on N1-P2 amplitude and, only for the FM group, the effect of medication and the correlation between AEPs and clinical variables. Contrary to the expectation, the patients showed a trend of reduced AEPs to the loudest tones (study 1) or no significant differences with the HCs (study 2). Medication with central effects significantly reduced AEPs, while no significant relationships between the N1-P2 amplitude/intensity function and patients' symptoms were observed. The findings do not provide evidence of augmented auditory processing in FM. Nevertheless, given the observed effect of medication, the role of sensory amplification as an underlying pathophysiological mechanism in fibromyalgia cannot be discarded.

Experiencia piloto con esquema rifapentina-isoniazida semanal por 3 meses para tratamiento de la infección tuberculosa latente en el Programa Nacional de Tuberculosis de Chile / Pilot experience with weekly rifapentine-isoniazid treatment for 3 months for latent tuberculosis infection at the Tuberculosis National Program of Chile

INTRODUCCIÓN: La prevención de la tuberculosis activa en los grupos de riesgo es clave para el control y eliminación de la tuberculosis. El tratamiento de la infección tuberculosa latente (TITL) con rifapentina e isoniazida en dosis semanales por 12 semanas es más corto que con otros esquemas, tiene menor hepatotoxicidad, mejor adherencia y es costo-efectivo. El OBJETIVO del estudio es evaluar la factibilidad de implementar este esquema a nivel programático en Chile. MÉTODOS: Se hizo una intervención piloto en territorios seleccionados entre mayo de 2018 y marzo de 2019. En esos territorios se reemplazó el esquema normado de TITL con isoniazida 6 meses por el esquema rifapentina-isoniazida 12 semanas. Además, se amplió la población objetivo, incluyendo a contactos mayores de 14 años. El tratamiento consistió en la administración conjunta de isoniazida y rifapentina por vía oral con frecuencia semanal, por 12 semanas, de forma supervisada por personal de salud. RESULTADOS: Ingresaron 238 pacientes al piloto, de los cuales 53% fueron mujeres y 54,2% fueron mayores de 14 años. Del total de pacientes, 203 (85,3%) completaron el tratamiento, 22 (9,2%) lo abandonaron, 8 (3,4%) presentaron reacciones adversas y 5 tuvieron otros motivos de egreso. CONCLUSIÓN: Tanto el TITL con rifapentinaisoniazida por 3 meses en dosis semanales supervisadas, como la incorporación de contactos adultos a TITL, son factibles de implementar a nivel programático en Chile.

INTRODUCTION: Prevention of active tuberculosis in risk groups is crucial in tuberculosis control and elimination. Treatment of latent tuberculosis (TITL) with rifapentine and isoniazid in weekly doses for 12 weeks is shorter than other pharmacological treatments, with less liver toxicity, better patient compliance and it is cost-effective. The OBJECTIVE of this study is to evaluate the feasibility to implement this treatment at a programmatic level in Chile. METHODS: A pilot intervention was conducted in selected territories between May 2018 and March 2019. Within these territories, the regulated treatment with isoniazid 6 months was replaced by the 12 weeks treatment with weekly rifapentine-isoniazide. Additionally, the target population was expanded to include contacts over 14 years old, currently not included in the national guidelines. Treatment consisted in oral administration of rifapentine and isoniazide together once a week for 12 weeks, under supervision of trained health workers. RESULTS: From 238 patients entered to the protocol, 53% of them were women and 54.2% were older than 14 years-old. Out of the total number of patients, 203 (85.3%) completed treatment, 22 (9.2%) abandoned, 8 (3.4%) had adverse drug reactions, and 5 ended treatment for different causes. CONCLUSION: Both TITL with rifapentine-isoniazide in 12 supervised weekly doses, and the inclusion of adult contacts in TITL, are feasible to implement at a programmatic level in Chile.

[What regulations have launched autonomous communities to going forward on patient safety culture in healthcare organizations?] / ¿Qué normativas han desarrollado las comunidades autónomas para avanzar en cultura de seguridad del paciente en sus organizaciones sanitarias?

INTRODUCTION: Patient Safety Culture is based on learning from incidents, developing preventive strategies to reduce the likelihood to happen and recognizing and accompanying those who have suffered unnecessary and involuntary harm derived from the health care received. To go ahead on patient safety culture entails facilitating the implementation of these behaviors and attitudes in healthcare professionals. Objective was to describe the regulations of some autonomous communities and national proposals for regulations changes. MATERIAL AND METHODS: Search of normative changes made in the autonomous communities of Catalonia, Navarra and the Basque Country. Proposals for legislative changes at national level were agreed. RESULTS: Activities and normative changes made in the autonomous communities of Catalonia, Navarre and the Basque Country are described and proposals for normative changes at the national level at short-term and long-term changes are made. In such a way that it is easier to advance in creating culture of patient safety in the whole National Health System CONCLUSION: Currently there is no global regulation that facilitates to advance in patient safety culture. Changes at the national legislation level are essential. It is at the Inter-territorial Council where the proposed legislative amendment should be defined, promoted by the representatives of the health systems of the autonomous communities.

Ceftolozane/tazobactam for the treatment of multidrug resistant Pseudomonas aeruginosa: experience from the Balearic Islands.

A prospective, descriptive observational study of consecutive patients treated with ceftolozane/tazobactam in the reference hospital of the Balearic Islands (Spain), between May 2016 and September 2017, was performed. Demographic, clinical, and microbiological variables were recorded. The later included resistance profile, molecular typing, and whole genome sequencing of isolates showing resistance development. Fifty-eight patients were treated with ceftolozane/tazobactam. Thirty-five (60.3%) showed respiratory tract infections, 21 (36.2%) received monotherapy, and 37 (63.8%) combined therapy for ≥ 72 h, mainly with colistin (45.9%). In 46.6% of the patients, a dose of 1/0.5 g/8 h was used, whereas 2/1 g/8 h was used in 41.4%. In 56 of the cases (96.6%), the initial Pseudomonas aeruginosa isolates recovered showed a multidrug resistant (MDR) phenotype, and 50 of them (86.2%) additionally met the extensively drug resistant (XDR) criteria and were only susceptible colistin and/or aminoglycosides (mostly amikacin). The epidemic high-risk clone ST175 was detected in 50% of the patients. Clinical cure was documented in 37 patients (63.8%) and resistance development in 8 (13.8%). Clinical failure was associated with disease severity (SOFA), ventilator-dependent respiratory failure, XDR profile, high-risk clone ST175, negative control culture, and resistance development. In 6 of the 8 cases, resistance development was caused by structural mutations in AmpC, including some mutations described for the first time in vivo, whereas in the other 2, by mutations in OXA-10 leading to the extended spectrum OXA-14. Although further clinical experience is still needed, our results suggest that ceftolozane/tazobactam is an attractive option for the treatment of MDR/XDR P. aeruginosa infections.

Mechanisms leading to in vivo ceftolozane/tazobactam resistance development during the treatment of infections caused by MDR Pseudomonas aeruginosa.

Objectives: Characterization of the mechanisms driving ceftolozane/tazobactam resistance development in 5 of 47 (10.6%) patients treated for MDR Pseudomonas aeruginosa infections in a Spanish hospital. Methods: Five pairs of ceftolozane/tazobactam-susceptible/resistant P. aeruginosa isolates were studied. MICs were determined by broth microdilution, clonal relatedness was assessed by MLST and resistance mechanisms were investigated by phenotypic and genotypic methods, including WGS. ampC variants were cloned to assess their impact on resistance. Results: In all five cases, the same clone was detected for the susceptible/resistant pairs; the widespread ST175 high-risk clone in four of the cases and ST179 in the remaining case. Genomic analysis of the four initial ST175 isolates revealed the characteristic OprD mutation (Q142X) responsible for carbapenem resistance and the AmpR mutation (G154R) responsible for AmpC overexpression and ß-lactam resistance. The final isolates had developed ceftolozane/tazobactam and ceftazidime/avibactam resistance, and each additionally showed a mutation in AmpC: E247K in one of the isolates, T96I in two isolates and a deletion of 19 amino acids (G229-E247) in the remaining isolate. The cloned AmpC variants showed greatly increased ceftolozane/tazobactam and ceftazidime/avibactam MICs compared with WT AmpC, but, in contrast, yielded lower MICs of imipenem, cefepime and particularly piperacillin/tazobactam. On the other hand, ceftolozane/tazobactam resistance development in ST179 was shown to be driven by the emergence of the extended-spectrum OXA ß-lactamase OXA-14, through the selection of an N146S mutation from OXA-10. Conclusions: Modification of intrinsic (AmpC) and horizontally acquired ß-lactamases appears to be the main mechanism leading to ceftolozane/tazobactam resistance in MDR P. aeruginosa.

Cytokine distribution in mothers and breastfed children after omega-3 LCPUFAs supplementation during the last trimester of pregnancy and the lactation period: A randomized, controlled trial.

OBJECTIVE: To determine whether maternal diet supplementation with omega-3 long chain polyunsaturated fatty acids (omega-3 LC-PUFAs) during the last trimester of pregnancy and the breastfeeding period influences the levels of inflammatory cytokines in mother and infants. MATERIAL AND METHOD: This registered, double-blind randomized study included 46 pregnant women, who were randomly allocated to either an experimental group receiving 400mL/day of a fish oil-enriched dairy drink [320mg docosahexaenoic acid (DHA) + 72mg eicoapentaenoic acid] (FO group, n = 24) or to a control group receiving 400mL/day of a non-supplemented dairy drink (CT group, n = 22), from week 28 of pregnancy until the fourth month of lactation. During the study, maternal dietary patterns were monitored by a nutritionist, who encouraged compliance with current recommendations of fatty acids intake. DHA concentrations and cytokine levels (GM-CSF, IL-2, IL-4, IL-6, IL-10, INF-γ and TNF-α) were measured in maternal plasma at the moment of recruitment and in maternal (n = 46) and infant (n = 46) plasma at birth and 2.5 months after birth. RESULTS: Maternal plasmatic IL-4 levels were higher in FO than in CT subjects (p = 0.009). Additionally, a tendency was observed to higher IL-10 and IL-2 in the FO group. Plasmatic IL-6 however, was higher in CT mothers (p = 0.001). TNF-α was higher in CT infants at birth and 2.5 months after birth (p = 0.005). An analysis of possible relationships between DHA and the concentrations of different cytokines revealed negative correlation between maternal plasmatic IL-6 and DHA (higher plasmatic DHA corresponded to lower IL-6). CONCLUSIONS: Maternal dietary omega-3 LC-PUFAs supplementation during critical periods like pregnancy, lactation and early newborn development may influence the levels of certain inflammatory cytokines, reducing pro-inflammatory cytokines and promoting an anti-inflammatory "environment".

Essential Subcortical Tracts in Language and Reading. 3D-Tractography for Clinical Practice and Anatomic Correlation with Intraoperative Subcortical Electrostimulation.

Diffusion tensor imaging (DTI) and tractography provide the neurosurgeon with a valid 3D view of the white matter tracts of the brain for the presurgical planning of the treatment of lesions close to eloquent areas, this being one of the principal clinical applications of this technique. In this article, we describe through practical cases the anatomic relationships of white matter tracts that are essential for language and reading, based on DTI studies and the excellent anatomic correlation with the intraoperative subcortical map.

Protein substitutes for phenylketonuria in Europe: access and nutritional composition.

BACKGROUND/OBJECTIVES: Protein substitutes (PS) are an essential component in the dietary management of phenylketonuria (PKU). PS are available as phenylalanine-free amino-acid mixtures (AAM), glycomacropeptide-based PS (GMP) and large neutral amino acids (LNAA). There is a lack of information regarding their availability in different countries and comparison of their nutritional composition is limited. The objectives of this study were to identify the number of PS available in different European countries and Turkey and to compare their nutritional composition. SUBJECTS/METHODS: Members of the European Nutritionist Expert Panel on PKU (ENEP) (Portugal, Spain, Belgium, Italy, Germany, Netherlands, United Kingdom, Denmark and Turkey) provided data on PS available in each country. The nutritional composition of PS available in Portugal was analyzed. RESULTS: The number of PS available in each country varied from 30 (Turkey) to 105 (Germany), with a median of 64. GMP was available only in Portugal, whereas LNAA was an option in Portugal, Italy, Turkey and Denmark. Some PS were designed for weaning. Many PS did not contain added fat and fiber. GMP contained the highest carbohydrate (CHO) and energy content as well as higher LNAA content compared with AAM. Only one AAM contained added fructo-oligosaccharides and galacto-oligosaccharides. AAM designed for the first year of life had the highest CHO, fat and LNAA contribution. Liquid AAM had lower CHO and fat contents compared with powdered AAM, but contained higher LNAA. CONCLUSIONS: There was widely dissimilar numbers of PS available in different countries. Nutritional composition of different PS was variable and should be considered before prescription.

[NUTRIENTS AND RADIOTHERAPY; REVIEW OF THE LITERATURE]. / NUTRIENTES Y RADIOTERAPIA; REVISIÓN DE LA LITERATURA.

INTRODUCTION: nutrition is an important influence on treatments and quality of life of cancer patients. The relationship between different nutritional components and radiotherapy is today a topic of growing interest. OBJECTIVE: to evaluate the influence of macro and micronutrients on tolerance and effectiveness of radiotherapy and their role in modulating chronic toxicity. MATERIALS AND METHODS: we performed a research of the published literature by consulting the MEDLINE database and Cochrane Library online between 1995 and 2015, relevant publications based on impact factor were selected. Data from the analyzed studies were exposed in sections by type of nutrient. RESULTS: most of the studies showed common features: small sample sizes, high heterogeneity, underpowered results and few prospective randomized studies. In the section of fiber, its use in prophylaxis and treatment of radiation enteritis has been successfully evaluated in some studies, although evidence of its recommendation is still weak. Omega 3 and omega 6 fatty acids have a high metabolic potential, however the evidence regarding this benefit is limited to observational studies in certain tumors. Among the amino acids, glutamine is the most studied, and controversial results of its effect on mucositis, esophagitis and radiation enteritis were found. Vitamins and minerals are a heterogeneous group of substances that showed potential benefit due to their antioxidant activity and their supposed protector effect against toxicity secondary to radiotherapy. Ketogenic diets are beginning to be clinically studied after promising preclinical results. CONCLUSIONS: the analyzed studies show controversial or inconclusive results regarding the influence of nutrients in the radiotherapy. It has been not found Sorong evidence about their role in patients receiving ionizing radiation. Well-designed, prospective and randomized studies are needed to establish recommendations.

Introducción: la nutrición ejerce una importante influencia sobre los tratamientos y la calidad de vida del paciente oncológico. En la actualidad, la relación de los distintos componentes nutricionales con el tratamiento radioterápico es un tema de creciente interés. Objetivos: evaluar la posible influencia de los macro y micronutrientes sobre la tolerancia y eficacia del tratamiento radioterápico, así como su papel en la modulación de la toxicidad crónica. Material y métodos: se ha realizado una revisión bibliográfica consultando las bases de datos MEDLINE y Biblioteca Cochrane online entre los años 2000 y 2015, seleccionando los trabajos más relevantes según factor de impacto. Los datos obtenidos de los estudios analizados se han expuesto por apartados según el tipo de nutriente. Resultados: la mayoría de los estudios analizados presentan características comunes: pequeños tamaños muestrales, alta heterogeneidad en estudios de un mismo tema, escaso poder estadístico, pocos estudios prospectivos y aleatorizados. En el apartado de la fibra, su empleo como profilaxis y tratamiento de la enteritis rádica ha sido evaluado con resultados satisfactorios en algunos estudios, aunque la evidencia de su recomendación es todavía débil. Los ácidos grasos omega­3 y omega­6 tienen una gran potencialidad metabólica, aunque la evidencia de su beneficio se limita a estudios observacionales en determinados tumores. Entre los aminoácidos, la glutamina es el más estudiado, con resultados contradictorios en el aporte de beneficio en la mucositis oral, la esofagitis y la enteritis rádica. Las vitaminas y minerales constituyen un grupo heterogéneo de sustancias con beneficio potencial por su actividad antioxidante y su posible efecto protector, disminuyendo la toxicidad producida por la radioterapia. Las dietas cetogénicas están comenzando a estudiarse clínicamente después de los prometedores resultados preclínicos. Conclusiones: los estudios analizados muestran resultados contradictorios o poco concluyentes respecto a la influencia de los nutrientes en el tratamiento radioterápico. No se pueden establecer en la actualidadrecomen daciones claras sobre su papel. Son necesarios estudios prospectivos y aleatorizados, bien diseñados, para poder establecer recomendaciones.

A novel configuration for an anaerobic submerged membrane bioreactor (AnSMBR). Long-term treatment of municipal wastewater under psychrophilic conditions.

A novel design for a pilot scale anaerobic submerged membrane bioreactor (AnSMBR) equipped with an ultrafiltration unit, treating municipal wastewater at 18 ± 2°C, and inoculated with a mesophilic inoculum without acclimation, was implemented and evaluated over 3 years of stable operation. The AnSMBR operated with a volumetric loading rate between 1.6 to 2.0 kg COD/m(3)UASBd, 12.8 to 14.2h hydraulic retention time, and reached a tCOD removal efficiency of around 90%. Biosolid production was between 0.05 and 0.083 g VS/g CODremoved. Dissolved methane oversaturation in the effluent was observed, reaching average values of 19.1 ± 0.84 mg CH4/L. The permeate flow rate ranged from 10 to 14L/m(2)h with trans-membrane pressure (TMP) values of 400-550 mbar, using cycles of 30s backwash, 7.5 min filtration, and continuous biogas sparging (9-16 m/h). During the three years of continuous operation, the membrane was not physically or chemically cleaned.

Long-term operation of a pilot scale anaerobic membrane bioreactor (AnMBR) for the treatment of municipal wastewater under psychrophilic conditions.

The performance of a pilot scale anaerobic membrane bioreactor (AnMBR), comprising an upflow anaerobic sludge blanket (UASB) reactor coupled to an external ultrafiltration membrane treating municipal wastewater at 18±2°C, was evaluated over three years of stable operation. The reactor was inoculated with a mesophilic inoculum without acclimation. The AnMBR supported a tCOD removal efficiency of 87±1% at hydraulic retention time (HRT) of 7h, operating at a volumetric loading rate (VLR) of between 2 and 2.5kgtCOD/m(3)d, reaching effluent tCOD concentrations of 100-120mg/L and BOD5 concentrations of 35-50mgO2/L. Specific methane yield varied from 0.18 to 0.23Nm(3)CH4/kgCODremoved depending on the recirculation between the membrane module and the UASB reactor. The permeate flow rate, using cycles of 15s backwash, 7.5min filtration, and continuous biogas sparging (40-60m/h), ranged from 10 to 14Lm(2)/h with trans-membrane pressure (TMP) values of 400-550mbar.

Filtering out repetitive auditory stimuli in fibromyalgia: a study of P50 sensory gating.

BACKGROUND: It has been suggested that fibromyalgia (FM) patients show increased sensory processing of nociceptive and non-nociceptive stimuli and also reduced habituation. Although this pattern of increased reactivity has been established for the somatosensory modality, its generalization to other sensory modalities remains controversial. METHODS: Auditory evoked potentials were obtained using a paired-stimuli paradigm from a sample of 52 FM female patients and 55 healthy women matched for age and socio-economic status. Sensory gating of the P50 component, as indicated by P50 suppression rates to the second identical stimuli, was analysed in relation to clinical indices of FM, including algometry of tender points and a number of self-reported questionnaires. RESULTS: Sensory gating mechanisms in FM patients proved to be normal, robust and as efficient as those recorded in control subjects. There was no correlation between P50 suppression rates and indices of clinical or experimental (threshold or tolerance) pain. In addition, P50 sensory gating was not related to the other main symptoms of FM, including fatigue, sleep dysfunction or co-morbid depression, nor to hypersensitivity to noise or headache. CONCLUSIONS: The results indicate that FM patients do not present significant deficits in early sensory gating when processing auditory stimuli, and therefore challenge the 'generalized hypersensitivity' hypothesis of FM.

Evaluation of corneal anaesthesia after the application of topical 2 per cent lidocaine, 0.5 per cent bupivacaine and 1 per cent ropivacaine in dogs.

The objective of this study was to describe and compare the efficacy and duration of topical anaesthesia induced by 2 per cent lidocaine (L), 0.5 per cent bupivacaine (B) and 1 per cent ropivacaine (R) in the dog using 24 clinically healthy beagles with normal ocular examination. Dogs were randomly divided into three groups: 2 per cent lidocaine (n=8), 0.5 per cent bupivacaine (n=8) and 1 per cent ropivacaine (n=8). The baseline corneal touch threshold (CTT) was measured using a Cochet-Bonnet aesthesiometer. Following baseline CTT measurement, a single drop of the assigned anaesthetic was applied to each eye and the CTT was measured bilaterally within one minute after administration and every five minutes until the basal CTT value was restored. Data were analysed with non-parametric analysis of variance models and Dunnet's test for post hoc analysis. One per cent ropivacaine was the most effective drug (LCTTmax=3 cm, BCTTmax=2 cm, RCTTmax=0 cm; P<0.001), and had the shortest latency (LLatency=5 minutes, BLatency=5 minutes, RLatency=1 minute; P<0.001) and the smallest AUC (LAUC=80 cm×minute, BAUC=68.25 cm×minute, RAUC=36.88 cm×minute; P<0.001). There was no statistical difference in the duration of corneal anaesthesia between the groups (P=0.09) and all topical anaesthetics tested reduced corneal sensitivity, although 1 per cent ropivacaine had the maximal and quickest anaesthetic effect. This drug could be used for specific diagnostic procedures where quick and short, but effective, corneal anaesthesia is needed.

Diagnóstico bacteriológico de tuberculosis pulmonar mediante fibrobroncoscopía en pacientes con VIH / Bacteriological diagnosis of lung tuberculosis through bronchoscopy in HIV-infected patients

Tuberculosis can be lethal in HIV infected people. Lung is the organ most frequently involved, but clinical and radiological features are not typical of the disease. Diagnostic certification demands acid-fast bacillus microscopy and mycobacterial cultures on sputum. Some patients need bronchoscopy to obtain samples due to insufficient sputum. We reported a 9.1 percent diagnostic yield using bronchoscopy. Clinical suspicion before bronchoscopy had low positive predictive value of tuberculosis (10.8 percent). 47.8 percent of tuberculosis cases were not suspected before this procedure. Tuberculosis patients showed CD4 < 200 cells/mL (48.8 in average) and less use of ART (antiretroviral therapy). Cultures contributed to the diagnosis of 35 percent of tuberculosis cases but with a delay of 30 days. Induced sputum is a less costly alternative to bronchoscopy with a similar diagnostic yield.

La tuberculosis puede ser letal en pacientes infectados por VIH. El compromiso pulmonar es más frecuente en ellos y su cuadro clínico-radiológico no es típico de la enfermedad. El diagnóstico se confirma con baciloscopía y cultivo de Koch en esputo. Los pacientes sin esputo pueden requerir broncoscopía. Encontramos un rendimiento de 9,1 por ciento en diagnóstico de tuberculosis pulmonar por broncoscopía. La sospecha clínica de tuberculosis previa a broncoscopía tuvo bajo valor predictivo positivo (10,8 por ciento). 47,8 por ciento de los pacientes con Tuberculosis no fueron sospechados antes de la broncoscopía por lo que recomendamos este procedimiento en pacientes VIH con alteraciones radiológicas y síntomas respiratorios. Los casos de tuberculosis tenían CD4 < 200 células/mL (promedio 48,8) y menos uso de TAR: terapia antiretroviral. El 35 por ciento de los casos de tuberculosis se diagnosticó por cultivo (demora mínima de 30 días). El esputo inducido es una alternativa a la broncoscopía menos costosa y de similar rendimiento.

Avanzando en la lucha contra la tuberculosis en Chile / Moving forward in the fight against tuberculosis in Chile

In 1973 Chile started a National Tuberculosis Control Programme based in the use of sputum smear for tuberculosis finding and proper treatment. Programme activities lead the country to achieve the threshold of tuberculosis elimination in year 2000. Since then the usual annual 7 percent decrease in the incidence of tuberculosis has leveled off. Between years 2009-2011 tuberculosis rate remained stationary in around 13.1 per 100.000 inhabitants. Such epidemiologic regression was related to a decrease in bacteriological case finding on primary health care and the existence of risk groups like the elderly, prisoners, migrants and HIV infected. The Metropolitan Region of Santiago represents 40 percent of the total incidence of tuberculosis of the country and has a higher proportion of high risk groups. We recommend to increase the tuberculosis detection rate focused in high risk groups, to increase preventive therapy of latent tuberculosis in HIV infected and close child contacts and improve treatment success. In year 2012 we have achieved a lower tuberculosis incidence rate of 12.6 per 100.000 inhabitants due to an increase in sputum smear detection. It is necessary to maintain this measures for the continuous progress in the control of tuberculosis.

Chile inició un programa de actividades de pesquisa bacteriológica y tratamiento de la tuberculosis a través de toda la red de salud nacional en 1973. Producto de esta iniciativa el país alcanzó el umbral de inicio de la eliminación de la enfermedad el año 2000. Desde entonces se ha enlentecido la velocidad de reducción de la incidencia de la enfermedad desde 7 por ciento anual hasta detenerse el año 2009. Entre el año 2009 y 2011 la incidencia se ha mantenido estacionaria con alrededor de 13,1 casos x 100.000 habitantes. Se han identificado algunos factores que han contribuido a esta detención epidemiológica, como por ejemplo la reducción de la pesquisa de los casos pulmonares bacilíferos, especialmente a nivel de atención primaria. También se ha encontrado una mayor concentración de casos entre población vulnerable constituida por grupos de riesgo como adultos mayores, personas privadas de libertad, migrantes e infectados por VIH. La Región Metropolitana aporta el 40 por ciento de los casos de tuberculosis y la proporción de población de riesgo de enfermar es mayor que en el resto del país. En el presente artículo se proponen estrategias para revertir esta situación. Las principales medidas son: incrementar la detección de casos en todos los niveles de salud con intensificación en los grupos de riesgo; aumentar las medidas preventivas con quimioprofilaxis en los infectados VIH y contactos infantiles y optimizar los resultados del tratamiento para interrumpir la cadena de transmisión de la enfermedad. Aún hay esperanzas. El año 2012 la incidencia se redujo a 12,6 x 100.000 y se incrementó la pesquisa baciloscópica después de varios años en que había disminuido. Mantener estas medidas se hace necesario para seguir avanzando en el control sanitario de la tuberculosis.

Antioxidant and genoprotective effects of spent coffee extracts in human cells.

Spent coffee has been shown as a good source of hydrophilic antioxidant compounds. The ability of two spent coffee extracts rich in caffeoylquinic acids, mainly dicaffeoylquinic acids, and caffeine (Arabica filter and Robusta espresso) to protect against oxidation and DNA damage in human cells (HeLa) was evaluated at short (2 h) and long (24 h) exposure times. Cell viability (MTT) was not affected by spent coffee extracts (>80%) up to 1000 µg/mL after 2 h. Both spent coffee extracts significantly reduced the increase of ROS level and DNA strand breaks (29-73% protection by comet assay) induced by H2O2. Pretreatment of cells with robusta spent coffee extract also decreased Ro photosensitizer-induced oxidative DNA damage after 24 h exposure. The higher effectiveness of Robusta spent coffee extract, with less caffeoylquinic acids and melanoidins, might be due to other antioxidant compounds, such as caffeine and other Maillard reaction products. This work evidences the potential antioxidant and genoprotective properties of spent coffee in human cells.

Evaluation of spent coffee obtained from the most common coffeemakers as a source of hydrophilic bioactive compounds.

The main hydrophilic antioxidant compounds (3-, 4-, and 5-monocaffeoylquinic and 3,4-, 3,5-, and 4,5-dicaffeoylquinic acids, caffeine, and browned compounds, including melanoidins) and the antioxidant capacity (Folin-Ciocalteu, ABTS, DPPH, Fremy's salt, and TEMPO) were evaluated in Arabica and Robusta spent coffee obtained from the preparation of coffee brews with the most common coffeemakers (filter, espresso, plunger, and mocha). All spent coffee grounds, with the exception of those from the mocha coffeemaker, had relevant amounts of total caffeoylquinic acids (6.22-13.24 mg/g of spent coffee), mainly dicaffeoylquinic acids (3.31-5.79 mg/g of spent coffee), which were 4-7-fold higher than in their respective coffee brews. Caffeine ranged from 3.59 to 8.09 mg/g of spent coffee. The antioxidant capacities of the aqueous spent coffee extracts were 46.0-102.3% (filter), 59.2-85.6% (espresso), and <42% (plunger) in comparison to their respective coffee brews. This study obtained spent coffee extracts with antioxidant properties that can be used as a good source of hydrophilic bioactive compounds.

Administración intrarterial de un magnetofluido termoterapéutico en un modelo experimental de metástasis hepáticas. Estudio de distribución con resonancia magnética y espectrometría / Magnetic resonance imaging and spectrometric study of the distribution of thermotherapeutic magnetofluid after intra-arterial administration in an experimental model of liver metastases

Objetivo. Valorar la distribución vascular de un magnetofluido por técnicas de imagen y laboratorio, en un modelo de metástasis hepáticas. Material y métodos. El hígado de 33 ratas WAG/RijCrl fue diseminado con células de carcinoma colorrectal CC-531. Tras comprobar desarrollo tumoral, diez ratas recibieron infusiones intrarteriales hepáticas de Lipiodol® con nanopartículas de Fe3O4 en suspensión, y cinco se reservaron como controles. Posteriormente, en RM de 1,5 T se practicaron secuencias axiales STIR (TR: 3.600ms/TE: 29ms/TI: 130ms) y eco de gradiente (EG) (120/4 y 120/14). Tras necropsia, según desarrollo tumoral, las ratas se clasificaron en dos estadios: precoz (< 10 metástasis, de < 3mm), avanzado (> 10 metástasis, de>3mm). De los 15 animales se tomaron muestras de hígado y metástasis, para cuantificar mediante espectrometría (ICP-MS) las concentraciones de hierro. En el análisis estadístico se emplearon pruebas no paramétricas. Se consideraron significativos valores de p < 0,05. Resultados. Cinco animales presentaron afectación precoz y cinco, avanzada. En secuencias EG, las metástasis en estadio precoz mostraron disminución homogénea de señal atribuible a presencia de magnetofluido. La espectrometría demostró diferencias significativas entre la concentración de hierro determinado en metástasis de ratas en estadio precoz y control (p=0,002), y entre animales en estadio precoz y avanzado (p=0,001). La razón entre hierro exógeno metastásico y hepático en ratas en estadio precoz fue 2,6:1. La concentración de hierro exógeno hepático y tumoral mostró diferencias significativas sólo en animales en estadio precoz (p=0,043). Conclusiones. RM y Espectrometría permitieron evaluar la distribución vascular hepática del magnetofluido, y revelaron su desigual afinidad por metástasis en diferentes estadios (AU)

Objective. To use imaging and laboratory techniques to evaluate the vascular distribution of magnetofluid in a rat model of liver metastases. Material and methods. The livers of 33 WAG/Rij Crl rats were seeded with CC-531 colorectal cancer cells. After we checked tumor development, 10 rats received hepatic intra-arterial infusions of Lipiodol® with nanoparticles of Fe3O4 in suspension, and 5 were reserved as controls. Axial STIR (TR: 3,600ms/TE: 29ms/TI: 130ms) and gradient-echo (GE) (120/4 and 120/14) MRI sequences were acquired on a 1.5 T scanner. After necropsy, rats were classified into one of two stages according to tumor development: early (< 10 metastases, each < 3mm) or advanced (> 10 metastases, each > 3mm). Samples of liver and of metastases were taken from the 15 animals for quantification of iron concentrations by inductively coupled plasma mass spectrometry (ICP-MS). The data were analyzed using nonparametric tests; values of p < 0.05 were considered significant. Results. Five animals had early tumor development and five had advanced tumor development. In the GE sequences, early stage metastases showed homogeneous signal reduction attributable to the presence of magnetofluid. Spectrometry found significant differences between the iron concentration in rats with early stage metastases and controls (p=0.002) as well as between rats with early stage metastases and those with late stage metastases (p=0.001). The ratio of exogenous iron in metastases and in liver in early stage rats was 2.6:1. The concentration of exogenous iron in the liver was significantly different from that in tumors only in early stage animals (p=0.043). Conclusions. MRI and spectrometry made it possible to evaluate the vascular distribution of magnetofluid in the liver and revealed the differences in its affinity for metastases in different stages of disease (AU)

[Magnetic resonance imaging and spectrometric study of the distribution of thermotherapeutic magnetofluid after intra-arterial administration in an experimental model of liver metastases]. / Administración intrarterial de un magnetofluido termoterapéutico en un modelo experimental de metástasis hepáticas. Estudio de distribución con resonancia magnética y espectrometría.

OBJECTIVE: To use imaging and laboratory techniques to evaluate the vascular distribution of magnetofluid in a rat model of liver metastases. MATERIAL AND METHODS: The livers of 33 WAG/Rij Crl rats were seeded with CC-531 colorectal cancer cells. After we checked tumor development, 10 rats received hepatic intra-arterial infusions of Lipiodol(®) with nanoparticles of Fe(3)O(4) in suspension, and 5 were reserved as controls. Axial STIR (TR: 3,600 ms/TE: 29 ms/TI: 130 ms) and gradient-echo (GE) (120/4 and 120/14) MRI sequences were acquired on a 1.5 T scanner. After necropsy, rats were classified into one of two stages according to tumor development: early (<10 metastases, each < 3mm) or advanced (>10 metastases, each >3 mm). Samples of liver and of metastases were taken from the 15 animals for quantification of iron concentrations by inductively coupled plasma mass spectrometry (ICP-MS). The data were analyzed using nonparametric tests; values of p < 0.05 were considered significant. RESULTS: Five animals had early tumor development and five had advanced tumor development. In the GE sequences, early stage metastases showed homogeneous signal reduction attributable to the presence of magnetofluid. Spectrometry found significant differences between the iron concentration in rats with early stage metastases and controls (p=0.002) as well as between rats with early stage metastases and those with late stage metastases (p=0.001). The ratio of exogenous iron in metastases and in liver in early stage rats was 2.6:1. The concentration of exogenous iron in the liver was significantly different from that in tumors only in early stage animals (p=0.043). CONCLUSIONS: MRI and spectrometry made it possible to evaluate the vascular distribution of magnetofluid in the liver and revealed the differences in its affinity for metastases in different stages of disease.