[Safety of thimerosal containing vaccines. Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society]. / Seguridad de las vacunas que contienen timerosal: Declaración del Comité Consultivo de Inmunizaciones (CCI) de la Sociedad Chilena de Infectología.

Thimerosal is a mercury derivative included in vaccines since 1930 with the aim to prevent microbial contamination. During the last decades, the use of thimerosal has been questioned, specifically because of a potential association with neurotoxicity. After a thorough review of published studies on pediatric use of thimerosal-containing vaccines, and of position papers from international expert groups, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases concludes that there is no solid evidence of adverse events associated with the use of thimerosal containing vaccines in infants and children. Therefore, a change in current vaccine practices refererred to thimerosal-containing vaccines is not justified in Chile.

[Rotavirus Vaccine. Statement of the Consultive Committee of Immunizations on behalf of The Chilean Infectious Diseases Society. March 2006]. / Declaración del Comité Consultivo de Inmunizaciones (CCI) de la Sociedad Chilena de Infectología respecto a vacuna anti-rotavirus. Marzo 2006.

The article briefly reviews the epidemiology of rotavirus infection and the scientific information of the rotavirus vaccines: Rotashield, withdrawn from the market due to its association with intussusception, Rotateq currently in an advanced phase of development, and Rotarix, recently licensed in Chile. Considering the available information, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases, summarizes its conclusions and makes recommendations for infants vaccination against rotavirus in our country.

Effects of cisapride on oesophageal transit of solids in patients with progressive systemic sclerosis.

In most patients with progressive systemic sclerosis (PSS) the oesophagus is affected. Reflux symptoms are most frequent, whilst dysphagia also occurs. Cisapride, a prokinetic agent, may enhance motility along the gastrointestinal tract. The effects of cisapride on oesophageal transit were evaluated in 12 PSS patient using a solid-phase radionuclide oesophageal transit study. Each PSS patient was given cisapride 10 mg or placebo orally three times a day in a random, double-blind, crossover fashion. The results show that cisapride does not seem to have any impact on oesophageal transit in patients with PSS.

Condition-specific role of colonic inflammatory molecules in persistent functional colorectal hypersensitivity in the mouse.

BACKGROUND: A low-level inflammation has been hypothesized to mediate visceral hypersensitivity in functional bowel disorders that persist after or even in the absence of gut inflammation. We aimed to test the efficacy of a steroidal anti-inflammatory treatment, and identify local inflammatory molecules mediating post- and non-inflammatory colorectal hypersensitivity using two mouse models. METHODS: Visceromotor responses to colorectal distension were quantified as a measure of colorectal sensitivity. On day 1, mice received intracolonic saline (control), trinitrobenzenesulfonic acid (postinflammatory on day 15), or acidified hypertonic saline (non-inflammatory). Colorectal sensitivity before (day 10) and after (day 15) 4-day dexamethasone (Dex) treatment was compared, and colonic gene expression of inflammatory molecules was quantified. KEY RESULTS: Dexamethasone effectively inhibited gene expression of inflammatory molecules such as interleukin (IL)-1ß and mast cell protease-1 in the colon, but did not attenuate colorectal hypersensitivity in either model. Gene expression of inflammatory molecules in the colon did not differ between control and the non-inflammatory model, but the postinflammatory model showed increased IL-10 and tight junction protein 2, and decreased IL-6, transforming growth factor (TGF)-ß, a precursor of ß-endorphin, occludin, and mucin 2. While no common molecule explained colorectal hypersensitivity in these models, hypersensitivity was positively correlated with TGF-ß2 mRNA in control, and with IL-1ß, inhibin ßA, and prostaglandin E2 synthase in the Dex-treated postinflammatory model. In the non-inflammatory model, cyclooxygenase-2 mRNA was negatively correlated with colorectal sensitivity. CONCLUSIONS & INFERENCES: These results suggest that persistent functional colorectal hypersensitivity is mediated by condition-specific mediators whose gene expression in the colon is not inevitably sensitive to steroidal anti-inflammatory treatment.

Dorsal root ganglion neurons innervating pelvic organs in the mouse express tyrosine hydroxylase.

Previous studies in rat and mouse documented that a subpopulation of dorsal root ganglion (DRG) neurons innervating non-visceral tissues express tyrosine hydroxylase (TH). Here we studied whether or not mouse DRG neurons retrogradely traced with Fast Blue (FB) from colorectum or urinary bladder also express immunohistochemically detectable TH. The lumbar sympathetic chain (LSC) and major pelvic ganglion (MPG) were included in the analysis. Previously characterized antibodies against TH, norepinephrine transporter type 1 (NET-1) and calcitonin gene-related peptide (CGRP) were used. On average, ∼14% of colorectal and ∼17% of urinary bladder DRG neurons expressed TH and spanned virtually all neuronal sizes, although more often in the medium-sized to small ranges. Also, they were more abundant in lumbosacral than thoracolumbar DRGs, and often coexpressed CGRP. We also detected several TH-immunoreactive (IR) colorectal and urinary bladder neurons in the LSC and the MPG, more frequently in the former. No NET-1-IR neurons were detected in DRGs, whereas the majority of FB-labeled, TH-IR neurons in the LSC and MPG coexpressed this marker (as did most other TH-IR neurons not labeled from the target organs). TH-IR nerve fibers were detected in all layers of the colorectum and the urinary bladder, with some also reaching the basal mucosal cells. Most TH-IR fibers in these organs lacked CGRP. Taken together, we show: (1) that a previously undescribed population of colorectal and urinary bladder DRG neurons expresses TH, often CGRP but not NET-1, suggesting the absence of a noradrenergic phenotype; and (2) that TH-IR axons/terminals in the colon or urinary bladder, naturally expected to derive from autonomic sources, could also originate from sensory neurons.

Differences in the expression of transient receptor potential channel V1, transient receptor potential channel A1 and mechanosensitive two pore-domain K+ channels between the lumbar splanchnic and pelvic nerve innervations of mouse urinary bladder and colon.

The bladder and distal colon are innervated by lumbar splanchnic (LSN) and pelvic nerves (PN) whose axons arise from dorsal root ganglia (DRG) neurons at thoracolumbar (TL) and lumbosacral (LS) spinal levels, respectively. In an attempt to understand the molecular basis of differences between LSN and PN mechanosensitive afferents, we analyzed the gene expression of two potentially counteracting ion channel groups involved in mechanosensation, transient receptor potential channels (TRPV1 and TRPA1) and mechanosensitive two pore-domain K(+) (K(2P)) channels (TREK-1, TREK-2 and TRAAK), in TL and LS DRG neurons innervating mouse bladder or distal colon. The proportion of TRPV1-expressing cells (41∼61%) did not differ between TL and LS neurons innervating bladder or colon. TRPA1 was seldom detected in bladder LS neurons whereas it was expressed in 64∼66% of bladder TL, colon TL and colon LS neurons. Coexpression of TRPV1 and TRPA1 was frequent. TREK-1-expressing cells were more prevalent in LS than TL ganglia in both bladder- and colon-DRG neurons. All three K(2P) channels were detected more frequently in TRPV1-positive neurons in TL ganglia. More than half of TL neurons expressing only TRPA1 were devoid of any of the three K(2P) channels, whereas all TL neurons expressing both TRPA1 and TRPV1 expressed at least one of the K(2P) channels. These results reveal clear differences between LSN and PN sensory pathways in TRPA1 and TREK-1 gene expression and in the gene expression of K(2P) channels in TRPV1-expressing neurons. This study further documents heterogeneity of visceral afferents based on combinations of the five channels examined.

[Human papillomavirus vaccine. Statement of the Advisory Committee of Immunizations on behalf of the Chilean Infectious Diseases Society. September 2008]. / Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de infectología respecto a la vacuna antivirus papiloma humano. Septiembre 2008.

This article briefly reviews the epidemiology of human papillomavirus (HPV) infection and associated diseases globally and in Chile, and the scientific information of the licensed HPV vaccines: Gardasil and Cervari. Considering the available information, the Advisory Committee on Immunizations of the Chilean Society of Infectious Diseases recommends vaccination of teenage girls, ideally before initiating sexual activity, i.e., approximately at the age of 12 to 13 years and vaccination of women of any age if they have not started sexual activity. If women are vaccinated after initiating sexual activity, they should be informed of the lower efficacy of immunization if HPV infection has occurred. Education on responsible sexuality and sexually transmitted diseases should be maintained as a priority. Vaccination should be highly considered for inclusion in the National Immunization Program.

El ámbito de la evaluación económica de intervenciones de salud / The scope of economic evaluation of healthcare interventions

The World Health Organization (WHO) has contributed to the conceptualization of a Health System stating that it has three main objectives and four functions. The main objective is Health Status, measured in Disability Adjusted Life Expectancy (DALE).The others two are Responsiveness to the people’s Non-Medical Expectations and Equity in Financing. This last is a specific indicator of economic nature. Economics has an increasing role in the health systems and the recognition of this component by actors in health services is more and more important every day. Medical professionals need to understand its meaning and relevance in many senses of medical care. Economic evaluations, mainly cost-effectiveness of health programs and socio-sanitary interventions are more complex to carry out than common social evaluations, whose context is more restricted.When formulating modern health policies, the declared objective is always the improvement and quality of healthcare. Nevertheless, in recent years policy makers have insisted in the need to secure economic rationality of interventions, both inside the program, thus achieving internal technical efficiency, as towards the whole society achieving allocative efficiency. When the purpose is to evaluate health programs, economic evaluation integrates costs with effectiveness and considers the epidemiologic profle and social preferences. The priority setting included in the Health Guarantees Plan (AUGE or GES) established by the Chilean Ministry of Health in 2005 is a clear example of a process of Health Technology Assessment , where cost-effectiveness studies were used to set the program and establish priorities. This is the frst in a series of papers related to economic evaluation of healthcare in-terventions. This paper aims to contribute to the development of this feld, providing basic concepts and its main applications to health care in Chile.

La Organización Mundial de la Salud (OMS) ha contribuido a la conceptualiza-ción de lo que es un sistema de salud, en el cual integra tres objetivos y cuatro funciones. El objetivo principal es la salud, la cual es medida con el indicador Expectativa de Vida Ajustada por Discapacidad (EVAD), los otros dos son Capacidad de Respuesta a las Expectativas No Medicas y la Equidad o Justicia Financiera. Esta última es una condición explícita de carácter económico. La economía tiene un papel creciente en los sistemas de salud y es importante que los actores principales del sistema, los profesionales médicos, estén al tanto de ello y logren comprender su dimensión. Las evaluaciones económicas, principalmente las de costo-efectividad de los programas de salud e intervenciones socio-sanitarias siguen siendo más complejas de realizar que las evaluaciones en otras áreas sociales, cuyo contexto es más restringido o específico. En la formulación de políticas de salud modernas, el objetivo declarado es siempre el de mejorar la calidad de los cuidados y de la atención médica. Sin embargo, ahora se hace insistiendo en que uno de los componentes esenciales de la calidad es la racionalidad económica de las intervenciones, tanto internas al propio programa, logrando eficiencia técnica, como al conjunto de la sociedad logrando eficiencia distributiva. Cuando se trata de evaluar Tecnologías Sanitarias, uno de sus componentes es la evaluación económica que integra costos con efectividad clínica y considera el perfilepidemiológico y las preferencias sociales. Estás últimas se pueden incorporar a través de la valoración de los estados de salud (en “outcomes” como Quality-Adjusted Life-Years -QALY) y en el uso de una tasa de descuento social. La determinación de las condiciones de salud incluidas en el Plan de Garantías en Salud (AUGE o GES) es un ejemplo de un proceso de Evaluación de Tecnologías Sanitarias (ETESA). En dicho proceso se hizo una aproximación a incluir explícitamente la evaluación económica, a través de los estudios de costo-efectividad, en la priorización para determinar las condiciones de salud que se integrarían al plan. Este es el primero de una serie de artículos sobre el ámbito de la evaluación económica de intervenciones de salud la que pretende entregar a la comunidad médica un conjunto de contenidos que dan luces sobre el desarrollo de la disciplina y sus conceptos principales, a la vez que sus aplicaciones posibles a las actividades de la salud en nuestro país.

Involvement of nitric oxide and vasoactive intestinal peptide in the nonadrenergic-noncholinergic relaxation of the porcine retractor penis muscle.

Neurotransmitters mediating nonadrenergic-noncholinergic (NANC) relaxation were investigated in strips of porcine retractor penis muscle (RPM). Muscle tone was raised by phenylephrine (1 microM) in the presence of atropine (1 microM) and guanethidine (50 microM). Upon electrical field stimulation (1 ms, 80 V, 1-32 Hz for 10 s), the initial fast relaxation was followed by the slow relaxation. Although the fast and the slow relaxation were completely abolished by tetrodotoxin (1 microM), they showed different pharmacological sensitivities to the nitric oxide (NO) synthase inhibitor N(omega)-nitro-L-arginine methyl ester (L-NAME, 0.1 mM). The fast relaxation was markedly inhibited by L-NAME in an L-arginine reversible manner and by oxyhemoglobin (50 microM), while the slow relaxation was hardly blocked by L-NAME. L-NAME and alpha-chymotrypsin (alpha-CT, 3 U/ml) selectively inhibited the fast and the slow relaxation, respectively. Alpha-CT abolished L-NAME-resistant slow relaxation, and L-NAME completely abolished the alpha-CT-resistant fast relaxation. Alpha-CT-resistant relaxation was not significantly different from the digitally calculated L-NAME-sensitive component, and L-NAME-resistant relaxation was similar to the digitally calculated alpha-CT-sensitive component. Vasoactive intestinal peptide (VIP, 0.003-0.1 microM) relaxed porcine RPM in a concentration-dependent manner. The effect of a VIP was partially inhibited by a VIP receptor antagonist, VIP(10-28) (1 and 3 microM). L-NAME-resistant relaxation was also reduced by VIP(10-28) (3 microM) and by another putative antagonist, VIP(6-28) (1 microM), although the effects of the two antagonists were somewhat inconsistent. From the histochemical staining, it was verified that nerve bundles that showed VIP-like immunoreactivities were also positive for the NADPH diaphorase reaction. These results suggest that NO and peptide neurotransmitter(s) including VIP mediate the NANC relaxation in porcine RPM.

Alternating dissociated nystagmus with palatal myoclonus--a case report.

An extraordinary eye movement was seen in a vegetative patient. His eyeballs were exotropic in the primary position and showed dissociated nystagmus which appeared alternately in each eye every few seconds. He also had palatal myoclonus quite asynchronous with the nystagmus. To our knowledge, there has been no such nystagmus documented in the literature. We report the new nystagmus with his EOG and brain MRI.

Declaración del Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología respecto a la vacuna antivirus papiloma humano: Septiembre 2008 / Human papillomavirus vaccine: Statement of the Advisory Committee of Immunizations on Behalf of the Chilean Infectious Diseases Society: September 2008

This article briefly reviews the epidemiology of human papillomavirus (HPV) infection and associated diseases globally and in Chile, and the scientific ínformatíon of the licensed HPV vaccines: Gardasil® and Cervarix®. Considering the available information, the Advisory Committee on Immunizations of the Chilean Society of Infectious Diseases recommends vaccination of teenage girls, ideally before initiating sexual actívíty, Le. approximately at the age of 12 to 13 years and vaccination of women of any age if they have not started sexual activity. If women are vaccinated after initiating sexual activity, they should be informed of the lower efficacy of immunization if HPV infection has occurred. Education on responsible sexuality and sexually transmitted diseases should be maintained as a priority. Vaccination should be highly considered for inclusion in the National Immunization Program.

Seguridad de las vacunas que contienen timerosal: Declaración del Comité Consultivo de Inmunizaciones (CCI) de la Sociedad Chilena de Infectología / Safety of thimerosal containing vaccines. Statement of the Consultive Committee of Immunizations on behalf of the Chilean Infectious Diseases Society

El timerosal es un derivado del mercurio utilizado desde 1930 como preservante de vacunas. En las últimas décadas ha sido cuestionada su seguridad, especialmente por la posibilidad de toxicidad neurológica. La revisión de varios estudios realizados en niños que recibieron vacunas que contienen timerosal y la posición de organismos de expertos internacionales en relación al uso de este compuesto en vacunas, permite al Comité Consultivo de Inmunizaciones concluir que no existe evidencia de eventos adversos en lactantes o niños por exposición al timerosal contenido en vacunas rutinarias y, por lo tanto, no habría razón para modificar las actuales prácticas de inmunización en Chile.

Thimerosal is a mercury derivative included in vaccines since 1930 with the aim to prevent microbial contamination. During the last decades, the use of thimerosal has been questioned, specifically because of a potential association with neurotoxicity. After a thorough review of published studies on pediatric use of thimerosal-containing vaccines, and of position papers from international expert groups, the Consultive Committee of Immunizations of the Chilean Society of Infectious Diseases concludes that there is no solid evidence of adverse events associated with the use of thimerosal containing vaccines in infants and children. Therefore, a change in current vaccine practices refererred to thimerosal-containing vaccines is not justified in Chile.

Declaración del Comité Consultivo de Inmunizaciones (CCI) de la Sociedad Chilena de Infectología respecto a vacuna anti-rotavirus: Marzo 2006 / Rotavirus vaccine: statement of the Consultive Committee of Immunizations on behalf of The Chilean Infectious Diseases Society: March 2006

Se presenta una breve revisión de la epidemiología de la infección por rotavirus y de los antecedentes científicos de las vacunas Rotashield®, retirada del mercado luego de mostrar asociación con invaginación intestinal en EEUU, Rotateq® actualmente en fases finales de desarrollo y Rotarix®, recientemente licenciada en Chile. Considerando estos antecedentes, el Comité Consultivo de Inmunizaciones de la Sociedad Chilena de Infectología, indica sus conclusiones y recomendaciones en relación a la vacunación anti-rotavirus de lactantes en nuestro país.

Estrategias de los médicos para hacer frente a la crisis de la profesión / Doctors' strategies to cope with the crisis in medical profession

This article reviews the strategies of doctors to face the crisis perceived in medical practice. The results of a descriptive study are compared with current data in medical literature. In that preliminary report, where physicians in different settings of practice were interviewed, the authors found a great variety of strategies, from passive resignation and escape behaviors, to a proactive conduct of information search and analysis of the changes under way. All groups interviewed reported the importance of systematic reflection, the need of life options, of adopting healthy life styles and spirituality, as strategies to cope with professional frustrations.

Prevalencia de hemocromatosis en trabajadores sanos. Importancia de añadir en la analítica de perfil bioquímico una saturación de transferrina / Prevalence of hereditary hemochromatosis among healthy workers: diagnostic value of transferrin saturation assay

Objetivo: La hemocromatosis es la enfermedad genética más común en la población blanca (dos a ocho casos por mil habitantes). Está caracterizada por una absorción excesiva de hierro, que conlleva a un acúmulo del mismo en diversos órganos. Su diagnóstico precoz, con la instauración de sangrías periódicas, condiciona que estos enfermos puedan igualarse a la población sana, tanto en calidad de vida como en sobrevivencia. Esto hace muy aconsejable la realización de despistaje de esta enfermedad en la población aparentemente sana. Aunque se han hecho grandes avances en los estudios genéticos de esta población, sigue siendo una saturación de transferrina (ST) elevada (superior a 60 porciento) el test más utilizado para iniciar una aproximación diagnóstica de la enfermedad. Nosotros realizamos ST a un grupo de trabajadores sanos para confirmar en nuestro medio la utilidad de este test en el diagnóstico de hemocromatosis. Método: Estudio prospectivo sobre 1.131 trabajadores activos que acuden a una revisión anual a un Centro Oficial de Seguridad e Higiene, practicándoseles a todos ST. Si ésta resulta elevada son derivados a un Centro Hospitalario para continuar con la aproximación diagnóstica de la hemocromatosis. Resultados: La ST resultó elevada en 22 trabajadores, de los cuales son estudiados 21 en un Centro Hospitalario. En once se normaliza la ST después de abstinencia de alcohol o al repetir el análisis. A nueve se les propone biopsia hepática, realizándose en seis. De estos seis se confirmó la hemocromatosis en tres, lo que hace una prevalencia confirmada, al menos, de 2.6 por mil habitantes. Conclusiones: Creemos que la saturación de transferrina es útil para iniciar el despistaje de hemocromatosis y que debería imponerse como parte del perfil bioquímico de analítica rutinaria. Otros métodos diagnósticos menos engorrosos que la biopsia hepática son necesarios para confirmar la enfermedad (AU)

La rehabilitación basada en la evidencia / Evidence based rehabilitation

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