Development of 3D-QSAR and pharmacophoric models to design new anti-Trypanosoma cruzi agents based on 2-aryloxynaphthoquinone scaffold.

In this work we have collected a set of 30 trypanosomicidal naphthoquinones and developed pharmacophoric and 3D-QSAR models as tools for the design of new potential anti-Chagasic compounds. Firstly, qualitative information was obtained from SAR and pharmacophoric models identifying some fragments around the 2-aryloxynaphthoquinone scaffold important for the antiparasitic activity. Then, 3D-QSAR CoMFA and CoMSIA models were developed. The models showed adequate statistical parameters where the steric, electrostatic, and hydrophobic features explain the trypanosomicidal effect. Therefore, to validate our models, we carried out the design, synthesis, and biological evaluation on T. cruzi epimastigotes of five new compounds (33a-e). According to CoMFA model, three out of five compounds showed pIC50 values within one logarithmic unit of deviation. The two compounds that did not fit the predictions were those with high lipophilicity, which agreed with the SAR and pharmacophore models. Docking and molecular dynamic studies were performed on T. cruzi trypanothione reductase, in a proposed binding site for this type of naphthoquinone. Interestingly, 33a-e showed the same interaction pattern as a naphthoquinone inhibitor (2). Finally, predicted drug-likeness properties indicated that 33a-e have optimal oral bioavailability. Thus, this study provides new in silico models for obtaining novel trypanosomicidal compounds.

Genotypic diversity of Salmonella ser. Abortusequi isolates from Argentina.

BACKGROUND: Salmonella enterica subsp. enterica serovar Abortusequi (S. Abortusequi) is a serotype restricted to equines, which produces abortion outbreaks. Nowadays the disease is being reported in different countries including Argentina thus generating an important impact in the equine industry. Molecular characterization of the 95 kb virulence plasmid and the spvC gene of S. Abortusequi demonstrated their importance in the pathogenicity of the serotype. In the last decades, high clonality of S. Abortusequi was identified in Japan, Mongolia and Croatia. OBJECTIVES: The aim of this work was to characterize S. Abortusequi isolates obtained in Argentina between 2011 and 2016 by virulence-gene profiling and pulsed-field gel electrophoresis. STUDY DESIGN: Case report. METHODS: S. Abortusequi isolates were studied by virulence-gene profiling and pulsed-field gel electrophoresis. RESULTS: Four virulence profiles and nine pulsed-field gel electrophoresis pulsotypes were identified among the 27 isolates included in the study. Different strains were found in the same outbreak and/or farm suggesting the presence of different sources of infection or mutation of isolates. MAIN LIMITATIONS: The number of related and nonrelated strains. More isolates may be necessary for a more intensive study. CONCLUSIONS: Most strains presented the same virulence profile, being positive for all the studied genes except gipA and sopE1, which are involved in intestinal virulence. Only few isolates showed different results in the same outbreak or farm. Unlike other studies, our results demonstrate a considerable diversity of S. Abortusequi pulsed-field gel electrophoresis pulsotypes, which suggests that different sources of infection may be involved within the same outbreak.

Anillo vascular completo por doble arco aórtico simétrico, una malformación cardiovascular infrecuente / Complete vascular ring by double symmetrical aortic arch, an infrequent cardiovascular malformation

Resumen Introducción: El doble arco aórtico (DAA) es una malformación cardiovascular infrecuente caracterizada por la persistencia de ambos arcos aórticos posterior al nacimiento. Puede presentarse con rama derecha dominante (70-73%), izquierda o simétrica. Su forma anatómica produce compresión de estructuras mediastínicas como la tráquea y esófago. Caso clínico: Lactante menor hombre de 3 meses, con antecedente de estridor desde nacimiento. Ingresó a nuestro centro por neumonía grave con necesidad de ventilación mecánica prolongada. Evaluado por otorrinolaringología, se realizó revisión de vía aérea, observando estenosis en los últimos 5 anillos traqueales con colapso dinámico de la tráquea. La tomografía computada de tórax demostró DAA completo con emergencias de troncos supraaórticos de ambos arcos de forma simétrica. Se decidió tratamiento quirúrgico a la brevedad. Se abordó por toracotomía anterolateral izquierda, se realizó control vascular y sección del arco aórtico izquierdo distal a emergencia de subclavia, con plastía de aorta y arteria subclavia izquierda, liberado el arco aórtico se realizó pexia y disección de tejido fibrótico que rodeaba tráquea y esófago. Paciente evolucionó favorablemente, con resolución de cuadro respiratorio y ausencia estridor. Fibrobroncoscopía posoperatoria no observó compresión traqueal. El alta hospitalaria fue al 14° día posoperatorio. Actualmente, a seis meses de seguimiento, se encuentra asintomático respiratorio y cardiovascular. Discusión: El DAA puede afectar al 0,03% de la población pediátrica. Usualmente es sintomático con manifestaciones obstructivas como estridor o disfagia por compresión de estructuras mediastínicas, por lo que requiere alta sospecha clínica para su confirmación imagenológica y posterior tratamiento quirúrgico.

Introduction: The double aortic arch (DAA) is an uncommon cardiovascular malformation, characterized by the persistence of both aortic arches after birth. It can be presented with right dominant branch (70-73%), left or symmetrical. It's anatomical shape produces compression of mediastinal structures such as the trachea and esophagus. Clinic case: Infant man 3 months old, with a history of stridor since birth. He was admitted to our center due to severe pneumonia with the need for prolonged mechanical ventilation. Evaluated by otorhinolaryngology, who performed airway revision observing stenosis in the last 5 tracheal rings with dynamic trachea collapse. Chest computed tomography showed complete DAA with emergence of supraaortic trunks of both arches symmetrically. Surgical treatment was decided as soon as possible. It was approached by left anterolateral thoracotomy, vascular control and left aortic arch section distal to subclavian emergency was performed, with aortic and left subclavian artery plasty, aortic arch was released to perform pexia and dissection of fibrotic tissue surrounding the trachea and esophagus. Patient evolved favorably, with resolution of respiratory symptoms and absence of stridor. Postoperative fiberoptic bronchoscopy did not observe tracheal compression. He was discharged on the 14th postoperative day. Currently at six months of follow-up, he is asymptomatic respiratory and cardiovascular. Discussion: AAD can affect 0.03% of the pediatric population. It is usually symptomatic with obstructive manifestations such as stridor or dysphagia due to compression of mediastinal structures, which requires high clinical suspicion for its imaging confirmation and subsequent surgical treatment.

Diet and body shape changes of paroko Kelloggella disalvoi (Gobiidae) from intertidal pools of Easter Island.

This study assesses seasonal variation in the morphology and diet of juveniles and adults of the Easter Island endemic goby Kelloggella disalvoi from intertidal pools during September-October 2015 (spring) and June-July 2016 (winter), utilizing geometric morphometric and gut-content analyses. A set of 16 landmarks was digitized in 128 individuals. Shape changes related to size changes (i.e. allometry) were low (18·6%) and were seasonally similar. Body shape changes were mainly dorsoventral (44·2% of variance) and comprised posteroventral displacement of the premaxilla and bending of the body. The latter included vertical displacement of the anterior portion of the first and second dorsal fins and the entire base of the caudal fin. Diets mainly comprised developmental stages of harpacticoid copepods (from eggs to adults), ostracods, isopods, gastropods and bivalves. Also, trophic niche breadth remained constant throughout development and did not vary between seasons. Nonetheless, significant dietary differences were detected in specimens collected during spring (main prey items: harpacticoid copepods and copepod eggs) and winter (harpacticoid copepods and copepod nauplii). Finally, there was weak but significant covariation between diet and morphology: molluscivores were characterized by having an inferior mouth gape, whereas planktivores had an anteriorly directed premaxilla.

Concordancia entre los modelos de SCORE y ramingham y las ecuaciones AHA/ACC como evaluadores de riesgo cardiovascular / Concordance between the SCORE and Framingham models and ACC/AHA equations as cardiovascular risk indicators

Resumen Objetivo: Diferentes modelos de evaluación de riesgo cardiovascular están actualmente en uso en Colombia. El objetivo de este estudio es analizar la concordancia entre las ecuaciones AHA/ACC 2013, SCORE y Framingham ajustado, así como el impacto de usar una u otra en la cantidad de pacientes clasificados como de alto riesgo y en la cantidad de pacientes que requerirían manejo farmacológico. Métodos: Se evaluaron 800 pacientes entre 40 y 74 años, de la clínica de prevención primaria del Hospital militar Central en Bogotá (Colombia), libres de eventos cardiovasculares. Se estimaron el riesgo a 10 años de enfermedad arterioesclerótica cardiovascular según las ecuaciones propuestas por las guías AHA/ACC 2013, el riesgo de muerte cardiovascular según la función SCORE de la guía europea y el riesgo coronario según la función de Framingham ajustada, recomendada por la guía colombiana. Se consideró como indicación de manejo farmacológico un cálculo de riesgo AHA/ACC o Framingham ajustado > 7,5%. Un riesgo de Framingham > 20% o SCORE > 5% definía el riesgo alto. Resultados: Según el Framingham había un 5,9% de pacientes de alto riesgo, según las ecuaciones de SCORE para países de bajo riesgo un 18,7% y según las ecuaciones de SCORE para países de alto riesgo, un 31,2%. El coeficiente Kappa mostró baja concordancia entre Framingham ajustado y cada una de las ecuaciones de SCORE (0,28 y 0,22 respectivamente). Según las recomendaciones de la guía AHA/ACC, el tratamiento hipolipemiante estaría indicado en un 40,8% de los pacientes, frente a un 50,6% según la guía colombiana (Framingham ajustado). El coeficiente kappa fue de 0,5735. Conclusiones: En la actualidad existe pobre acuerdo entre las diferentes escalas de evaluación del riesgo cardiovascular usadas en Colombia, hecho que conlleva incertidumbre para la toma de decisiones terapéuticas. Los datos de este estudio demuestran la necesidad de validar los modelos de SCORE y AHA/ACC en Colombia y Latinoamérica.

Abstract Motivation: In Colombia, different models of cardiovascular risk assessment are currently being used. The motivation of this study is to analyse the concordance between the ACC/AHA 2013 equation, SCORE and adjusted Framingham, as well as the impact of using one or another in the amount of patients classified as high risk and the amount of patients requiring pharmacological management. Methods: 800 patients between 40 and 74 years old were assessed, from the primary prevention clinic of the Hospital Militar Central in Bogotá (Colombia), who were free of cardiovascular events. 10-year risk for atherosclerotic vascular disease was estimated according to the equations proposed by ACC/AHA 2013 guides, the risk of cardiovascular death according to the SCORE function of the European guide and the coronary risk according to the adjusted Framingham function recommended by the Colombian guide. The indication of pharmacological management was considered with an ACC/AHA or adjusted Framingham risk of > 7.5%. A >20% Framingham or a >5% SCORE risk were considered high risk. Results: According to Framingham there was a 5.9% of high-risk patients, according to SCORE equations for low-risk countries an 18.7% and according to SCORE equations for high-risk countries, a 31.2%. The Kappa coefficient showed a low concordance between adjusted Framingham and each of the SCORE equations (0.28 and 0.22 respectively). According to the ACC/AHA guide recommendations, hypolipidemic treatment would be indicated in 40.8% of patients, versus a 50.6% following the Colombian guide indications (adjusted Framingham). Kappa coefficient was 0.5735. Conclusions: Nowadays there is a poor agreement between the different cardiovascular risk assessment scales used in Colombia, thus generating uncertainty when it comes to making therapeutic choices. Data from this study show the need to validate the validate the SCORE and ACC/AHA models in Colombia and Latin America.

Membrane technology applied to acid mine drainage from copper mining.

The objective of this study is to evaluate the treatment of high-strength acid mine drainage (AMD) from copper mining by nanofiltration (NF) and reverse osmosis (RO) at pilot scale. The performances of two commercial spiral-wound membranes - NF99 and RO98pHt, both from Alfa Laval - were compared. The effects of pressure and feed flow on ion rejection and permeate flux were evaluated. The results showed high ion removal under optimum pressure conditions, which reached 92% for the NF99 membrane and 98% for the RO98pHt membrane. Sulfate removal reached 97% and 99% for NF99 and RO98pHt, respectively. In the case of copper, aluminum, iron and manganese, the removal percentage surpassed 95% in both membranes. Although concentration polarization limited NF performance at higher pressures, permeate fluxes observed in NF were five times greater than those obtained by RO, with only slightly lower divalent ion rejection rates, making it a promising option for the treatment of AMD.

Diagnóstico final de pacientes con sospecha de accidente cerebrovascular descartado. Experiencia del Hospital de Chillán, chile / Final diagnosis of patients with suspect of ruled out stroke. experience of the Hospital of Chillán, Chile

INTRODUCCIÓN: El accidente cerebrovascular (ACV) es una lesión neurológica aguda con dos subtipos clásicos (isquémico y hemorrágico); siendo un importante problema de salud púbica en Chile. Existen patologías que imitan su presentación, sin embargo, una historia clínica y examen físico orientado permiten discriminar en un alto número de casos entre estas patologías evitando la derivación a especialista y solicitud de exámenes imagenológicos, disminuyendo así, los costos derivados en un gran número de pacientes. MATERIAL Y MÉTODO: Estudio transversal a partir de las fichas clínicas de pacientes ingresados con sospecha de ACV durante febrero y marzo del 2016 en Hospital Clínico Herminda Martín de Chillán para su confirmación diagnóstica por el Servicio de Neurología. RESULTADOS: Se obtuvieron 304 fichas clínicas con sospecha de ACV de las cuales un 26,9% no correspondieron a ACV. De estos, 45,9% eran patologías de especialidades no neurológicas siendo las más frecuentes las derivadas de Medicina Interna. DISCUSIÓN: El ACV es una entidad neurológica clásicamente descrita en base a la ubicación de la lesión vascular. Pese a que su presentación semiológica es conocida, existen muchas patologías que son clínicamente similares, o bien, las características singulares de los pacientes hacen que el patrón clínico sea confuso. Este fenómeno se refleja en una tasa de falsos ACV relativamente similar entre diferentes centros de salud. La tasa de error en diagnóstico de ACV en el estudio es de 26,9%, similar a otras experiencias. Pareciera ser que existe un número basal de falsos ACV, cuyo margen de error clínico, resulta difícil reducir aún con buenas escalas y protocolos estandarizados de atención.

INTRODUCTION: Stroke is an acute neurological lesion with two classic subtypes (ischemic and hemorrhagic), being an important public health problem in Chile. There are pathologies that mimic its presentation, however, a clinical history and oriented physical examination allow to discriminate in a high number of cases between these pathologies avoiding the referral to specialist and request of imaging examinations, thus reducing, the costs derived in a large number of patients. MATERIAL AND METHOD: Cross-sectional study from the clinical records of patients admitted with suspected stroke during February and March of 2016 at Herminda Martin Clinic Hospital from Chile for diagnostic confirmation by the Neurology Service. RESULTS: A total of 304 clinical files were obtained with suspected stroke, of which 26,9% did not correspond to stroke. Of these, 45,9% were pathologies of non-neurological specialties, the most frequent being those derived from internal medicine. DISCUSSION: Stroke is a neurological entity classically described based on the location of the vascular lesion. Although its semiologic presentation is known, there are many pathologies that are clinically similar, or the unique characteristics of the patients make the clinical pattern confusing. This phenomenon is reflected in a relatively similar false stroke rate among different health centers. The error rate in diagnosis of stroke of this study is 26,9%, similar to other experiences. It appears that there is a basal number of false stroke, whose clinical margin of error is difficult to reduce even with good scales and standardized care protocols.

Infección por adenovirus en el Hospital de niños Roberto del Río 2016 / Adenovirus infection at the Roberto del Río children's Hospital 2016

En los meses de invierno, las enfermedades respiratorias representan la primera causa de hospitalización en hospitales pediátricos. La mayoría de estas enfermedades son causadas por virus, dentro de los cuales se encuentra el adenovirus (AdV), el cual puede generar infecciones diseminadas graves, secuelantes e incluso letales y se caracteriza por tener una rápida transmisión entre pacientes, generando brotes intrahospitalarios. Se identificó a 54 pacientes hospitalizados con infección por adenovirus en el periodo de marzo-julio del 2016 con una edad promedio de 18,3 meses, de los cuales 23 casos fueron infecciones asociadas a la atención de salud (IIAS) y 2 tuvieron desenlace fatal. Los casos de IIAS, se asociaron a una mayor tasa de hospitalización prolongada (p= <0.01), ingreso a UPC (p= <0.01) y uso de ventilación mecánica (p= <0.01). No se encontró asociación entre la presencia de antecedentes mórbidos con el desarrollo de IIAS. Las IIAS por adenovirus se asocia a una hospitalización prolongada, ingreso de unidades de alta complejidad y necesidad de uso de ventilación mecánica. Dado que el adenovirus se transmite a través de contactos directo, aerosoles y fómites, las medidas básicas de precaución de contacto y de aislamiento permiten reducir los contagios nosocomiales, recayendo la responsabilidad en todo el equipo de salud a cargo.

Respiratorio deseases are frequent in winter times. being the main cause of hospital admissions. Viral infecciones are the main etiology, and adenovirus infección clould lead to severe disease, with cross infections. We identified 54 patients admitted to the Roberto del Río Childrens hospital in 2016, with a mean age of 18,3 months old; 23 cases where nosocomial infection, and 2 were fatal. Hospital acquired adenovirus infection were associated to long hospital stay (p= <0.01), intensive care admission (p= <0.01) and ventilatory support (p= <0.01). We did not find previous illness conditions. Adenovirus hospital acquired infection is associated with longer hospital stay and dead. Adenovirus is transmitted with direct contact, aerosols and fomites, therefore basic contact precautions are important.

Edible antimicrobial films based on microencapsulated lemongrass oil.

Edible films and coatings have been proposed as viable alternatives for the preservation of fresh food such as fruit, meat, fish and cheese. They can be designed to contain natural antioxidants, vitamins and antimicrobials in order to extend shelf life of the product keeping the natural sensorial properties. Essential oils have been targeted as potential active principles for edible films and coatings given their well-recognized antioxidant, antimicrobial and sensory properties. In the present work, lemongrass oil (LMO) microcapsules were prepared by the emulsification-separation method using sodium caseinate as wall material. Microcapsules had an average size of 22 µm and contained over 51 % oil in their nucleus. The release kinetics of the LMO components was studied for both, microcapsules and microcapsule containing films. Experimental data for the controlled release of LMO components showed good correlation with Peppas and Weibull models. The effect of the alginate matrix on the release parameters of the mathematical models could be detected by the modification of the b constant of the Weibull equation which changed from 0.167 for the microcapsules to 0.351 for the films. Films containing LMO at concentrations of 1250, 2500 and 5000 ppm were able to inhibit growth of Escherichia coli ATCC 25922 and Listeria monocytogenes ISP 65-08 in liquid cultures. A possible future application of these films for shelf life extension of fresh food is discussed.

Respuesta patológica completa en pacientes sometidos a neoadyuvancia en cáncer de recto / Pathologic complete response in patients with neoadjuvant chemoradiotherapy for rectal cancer

Background: the standard treatment of locally advanced rectal cancer (RC) of the middle and lower third of the rectum is neoadjuvant chemoradiotherapy (XRQT) follow by oncologic resection. After this treatment in 15-25 percent of the cases, the pathologist reports complete pathological response (pCR). Aim: to describe demographic, clinical and survival data of patients with pCR undergoing chemoradiotherapy and radical resection for RC. Material and Methods: historic cohort study. In a prospectively maintained database between 2000 and 2010, we identified patients with RC, who underwent neoadjuvant chemoradiotherapy according to protocol, followed by radical resection. The preoperative staging was obtained by clinical examination, endoscopy, rectal ultrasound, CT scan of chest, abdomen and pelvis and pelvic MRI. Demographic data, tumor location, time between the end of XRTQ and surgery, postoperative staging (according AJCC) and survival, were collected. Results: 119 patients received preoperative XRTQ, 65 percent male, with a mean age of 58 years. The most frequent tumor site was the lower third (63 percent). Surgery was performed 8 weeks after the end of XRTQ. Of 119 patients with XRTQ, 15.1 percent had a pCR. Overall survival was 75 percent, and cancer-specific survival was 80.4 percent at 5 years in patients without pCR. For patients with pCR, the 5 year survival estimates for overall and cancer specific survival was 100 percent. We did not identify factors associated with pCR. Conclusions: in this study, pCR was comparable to other larger series reported elsewhere. No factors associated with pCR were identified.

Introducción: el cáncer de recto (CR) de tercio medio e inferior localmente avanzado se trata con radio-quimioterapia (XRTQ) preoperatoria. Luego XRQT y resección quirúrgica, 15-25 por ciento presentan respuesta patológica completa (RPC) de la lesión. Objetivo: comparar características demográficas, clínicas y sobrevi da de pacientes con RPC y respuesta parcial sometidos XRTQ preoperatoria y resección radical. Materiales y Métodos: estudio cohorte concurrente. En la base de datos de pacientes con CR mantenida prospectivamente, entre 2000-2010, se identificaron pacientes con CR tercio medio e inferior, sometidos XRTQ preoperatoria según protocolo, seguidos de resección radical. Etapificación preoperatoria según: examen clínico, endoscopia, endosonografía rectal, TAC tórax abdomen pelvis y resonancia nuclear magnética de pelvis. Se registraron datos demográficos, localización tumoral, lapso entre término de XRTQ y cirugía, etapificación post operatoria (AJCC), seguimiento y sobrevida. Resultados: 119 pacientes recibieron XRTQ preoperatoria por CR, 65 por ciento hombres. Edad promedio: 58 años. Localización tumoral más frecuente: tercio inferior (63 por ciento). Cirugía se realizó 8 semanas después del término de XRTQ. Etapificación post operatoria: Etapa I 26,1 por ciento, II 34,5 por ciento, III 16,8 por ciento, IV 5 por ciento y RPC 15,1 por ciento. Sobrevida global 75 por ciento, sobrevida específica por cáncer 80,4 por ciento a 5 años. Sobrevida pacientes con RPC fue 100 por ciento a 5 años. No se identificaron factores asociados a RPC. Conclusiones: en este estudio no se logró reconocer factores asociados a RPC. Con las limitaciones que impone el número de pacientes y el seguimiento, se reproducen hallazgos vistos en series más extensas.

Aspergilosis necrotizante crónica: reporte de un caso / Chronic necrotizing aspergillosis: report a case

INTRODUCCIÓN: el Aspergillus fumigatus es un patógeno poco frecuente en la población general, que produce una infección en personas inmunodeprimidas cuando se inhalan sus esporas, las cuales se pueden depositar en senos paranasales, nasofaringe, en los pulmones y posteriormente comprometer incluso tejidos distintos a las de la vía aérea. Uno de los cuadros clínicos pulmonares es la aspergilosis necrotizante crónica (ANC), en donde se produce una invasión local del parénquima pulmonar con destrucción y formación de cavidades, sin invasión de vasos sanguíneos ni a otros órganos. PRESENTACIÓN DEL CASO: Paciente de 57 años, sexo femenino, quien tuvo múltiples consultas en la asistencia pública por síntomas respiratorios en el Hospital Clínico Regional de Concepción, se realizó una biopsia transbronquial del lóbulo superior derecho cuyo informe histopatológico informó la presencia de tejido necrótico, abundantes colonias con hifas y conidias consistentes con Aspergillus, por lo cual se diagnosticó ANC y se decidió tratar con itraconazol de 200 mg cada 12 horas por 26 semanas y prednisona 20 mg vía oral hasta completar tratamiento antifúngico. DISCUSIÓN: Si bien la ANCes una enfermedad que afecta a pacientes inmunodeprimidos también se debe considerar como una posibilidad diagnóstica a pesar de estar frente a un paciente inmunocompetente, ya que es una patología potencialmente fatal y que puede presentar complicaciones como compromiso de la pared torácica, plexo braquial y columna vertebral.

INTRODUCTION: Aspergillus fumigatus is a rare pathogen in the general population that produces an infection in depressed immune persons when inhaled spores, which can be deposited in sinuses, nasopharynx and lungs. One of pulmonar disease, is the Chronic Necrotizing Aspergillosis (CNA), where there is a local invasion on lung parenchyma with destruction and cavitation, without invasion of blood vessels or other organs. CASE REPORT: A 57 year old female who had multiple consultations on public assistance for respiratory symptoms in the Regional Hospital of Concepción, were taken a transbronchial biopsy was performed in the middle lobe, whose pathology report informed presence of necrotic tissue, abundant colonies with hyphae and conydias, that are consistent with Aspergillus and thus was diagnosed CNA and decided to deal with itraconazole 200 mg every 12 hours for 26 weeks and 20mg prednisone oral until complete antifungal treatment. DISCUSSION: Although the CNA is a disease that affects immune depressed patients should also be considered as a diagnostic possibility in spite of being an immune competent patient, since it is a potentially fatal disease that may present complications like chest wall involvement, brachial plexus and spine.

Púrpura Schõnlein Henoch con compromiso renal: reporte de un caso / Henoch Schõnlein purpura with renal involvement: case report

INTRODUCCIÓN: El Púrpura Schõnlein Henoch es una vasculitis sistémica que afecta principalmente a la piel, articulaciones, sistema gastrointestinal y renal. Es una de las vasculitis más comunes en la infancia. El compromiso renal se da en aproximadamente el40 por ciento de los casos, y en la mayoría se presenta con hematuria, sin embargo, también puede manifestarse como proteinuria, síndrome nefrótico y nefrítico. PRESENTACIÓN DEL CASO: Se presenta el caso de una paciente de 6 años que consulta en Servicio de Urgencia por dolor en el tarso del pie izquierdo de 4 días de evolución, sin antecedentes de trauma, acompañándose de dolor en rodilla izquierda con limitación a la movilización, y lesiones purpúricas en extremidades inferiores. Durante la hospitalización, la paciente presentó al inicio presiones arteriales altas y oliguria, manejándose con antihipertensivos, además del inicio del tratamiento con corticoides. Luego de la mejoría del compromiso articular y cutáneo, se evidenció compromiso renal con proteinuria, que al persistir se aumentó las dosis de corticoides, teniendo favorable respuesta al disminuir sus niveles. Al encontrarse en mejores condiciones, se decidió manejo ambulatorio manteniendo tratamiento corticoidal y antihipertensivo, controlándose en Nefrología y Reumatología Infantil. DISCUSIÓN: Se concluye de este trabajo que la corticoterapia y el manejo de la presión arterial fueron pilares fundamentales para el tratamiento en este caso, mejorando su evolución clínica y principalmente la disminución de la proteinuria con el uso de los corticoides, evitando un compromiso mayor a pesar de que no esté comprobado su beneficio en la literatura.

INTRODUCTION: The Henoch Schõnlein Purpura is a systemic vasculitis that mainly affects the skin, joints, gastrointestinal system and renal system. It is one of the most common vasculitis in childhood. Renal involvement occurs in approximately40 percent of cases, and in most cases it occurs with hematuria. However, it may also manifest as proteinuria, nephrotic and nephritic syndrome. CASE REPORT: We report the case of a 6-year old patient who consulting in the emergency service for 4 days with pain in left foot tarsal, without a history of trauma, accompanied by pain in left knee with limited mobilization, and purpuric lesions in lower extremities. During hospitalization, the patient presented at the beginning high blood pressure and oliguria, handling itself with antihypertensive, in addition to the initiation of treatment with corticosteroids. After improvement of cutaneus and articular involvement, renal involvement was evident with proteinuria, at persist was increased doses of corticosteroids, with favorable response to decrease levels. Being in better conditions was decided ambulatory management keeping antihypertensive and corticosteroid treatment, controlling in Nephrology and Child Rheumatology. DISCUSSION: It can be concluded from this study that the steroids and blood pressure management were fundamental pillars for the treatment in this case, improving their clinical course and mainly the proteinuria decreased with the use of corticosteroids, preventing a greater commitment although is not verified in the literature their advantage.

Tratamiento del cáncer de próstata con radioterapia por modulación de intensidad, primera experiencia en Chile / Intensity modulated radiotherapy treatment for prostate cancer, first experience in Chile

Background: Intensity modulated radiotherapy (IMRT) is an important step forward in cancer treatment. Aim: To report the first experience in Chile with IMRT for prostate cancer and compare the results obtained with different doses. Patients and Methods: From January 1997 through June 2008, 156 patients with a mean age of 70 years, were treated with radiotherapy and 121 with IMRT. Patients were staged according to American Commission on Cancer Staging. Their biochemical relapse risk was classified according to the MD Anderson classification. Patients were routinely checked during and after therapy to evaluate side effects and relapse. Results: Median follow up was 46 months (4-120). Overall five years survival was 85%. Biochemical relapse free five years survival for low, intermediate and high risk patients was 100, 82 and 70%, respectively. Biochemical relapse free survival for patients receiving radiotherapy doses over 76 Gy was 83%, compared to 30% for those receiving lower doses (p < 0.05). Urinary and gastrointestinal acute toxicity was low in 80% and 90% of patients respectively. Late toxicity developed in less than 3% of patients. Conclusions: IMRTforprostate cancer is readily available and safe in Chile. Biochemical disease free survival improved with higher doses with low toxicity rates.

[Intensity modulated radiotherapy treatment for prostate cancer, first experience in Chile]. / Tratamiento del cáncer de próstata con radioterapia por modulación de intensidad, primera experiencia en Chile.

BACKGROUND: Intensity modulated radiotherapy (IMRT) is an important step forward in cancer treatment. AIM: To report the first experience in Chile with IMRT for prostate cancer and compare the results obtained with different doses. PATIENTS AND METHODS: From January 1997 through June 2008, 156 patients with a mean age of 70 years, were treated with radiotherapy and 121 with IMRT. Patients were staged according to American Commission on Cancer Staging. Their biochemical relapse risk was classified according to the MD Anderson classification. Patients were routinely checked during and after therapy to evaluate side effects and relapse. RESULTS: Median follow up was 46 months (4-120). Overall five years survival was 85%. Biochemical relapse free five years survival for low, intermediate and high risk patients was 100, 82 and 70%, respectively. Biochemical relapse free survival for patients receiving radiotherapy doses over 76 Gy was 83%, compared to 30% for those receiving lower doses (p < 0.05). Urinary and gastrointestinal acute toxicity was low in 80% and 90% of patients respectively. Late toxicity developed in less than 3% of patients. CONCLUSIONS: IMRT for prostate cancer is readily available and safe in Chile. Biochemical disease free survival improved with higher doses with low toxicity rates.

Comparison of bioreactors with different kinds of submerged packed beds for domestic wastewater treatment.

The performance of aerobic submerged packed bed reactors was studied for the treatment of domestic wastewater using different kinds of packing materials with high specific areas (760-1,200 m(2)/m(3)). The tested materials were ceramic spheres, crushed tezontle, grains of high density polyethylene (HDPE), of low density polyethylene (LDPE) and of polypropylene (PP), cubes of polyurethane (PU) and polyethylene tape (SESSIL). The bioreactors were operated in continuous regime, applying organic loads in the range of 0.8-6.0 g COD.m(-2).d(-1). The obtained specific COD removal rates were very similar in all the reactors when they were operated at organic loads up to 2.0 g COD.m(-2).d(-1), after which differences in effectiveness appeared and the best results were determined in the reactors with SESSIL, LDPE and PU. Very low TSS, O&G and turbidity were obtained in all the effluents. The NH(3)-N and TN removals were dependent on the dissolved oxygen (DO) concentration and the removals at DO of 5 mg/l were 84-99% and 61-74% respectively. The best removals were determined in the reactors with PU, SESSIL and LDPE. The reactor with tezontle had also a good performance when operated with loads up to 1.0 g TN.m(-2).d(-1). The best phosphate removals (38-49%) were obtained in the reactors with PU, tezontle, ceramic sheres and SESSIL.

[Waist circumference, dyslipidemia and hypertension in prepubertal children]. / Circunferencia de cintura, dislipidemia e hipertensión arterial en prepúberes de ambos sexos.

OBJECTIVE: To explore the relationship between anthropometric variables, lipid concentrations and blood pressure in a sample of prepubertal children and to asses the importance of waist circumference in identifying certain cardiovascular risk factors in this age group. METHODS: A cross-sectional analysis of a random sample of prepubertal children aged 2 to 9 years old was performed. Height, weight, triceps skinfold, body mass index, waist circumference, and systolic and diastolic blood pressure were measured. Plasma levels of triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and glucose were determined. RESULTS: A total of 240 prepubertal children were studied. There were 123 (51.3 %) boys and 117 (48.8 %) girls. The prevalence of overweight, high blood pressure and insulin-resistance syndrome was 16.6 %, 3.7 % and 1.2 %, respectively. Triceps skinfold and fat mass were significantly higher in girls. There were no significant differences in lipid profiles between obese children and those with a healthy weight. Waist circumference had a positive and significant correlation with high-density lipoprotein cholesterol, systolic blood pressure, and diastolic blood pressure. Furthermore, waist circumference was also associated with a greater risk of elevated values of total cholesterol, triglycerides and hypertension. CONCLUSION: Waist circumference may be a helpful parameter in identifying prepubertal children with an adverse lipid profile and hypertension.

Evaluación de un modelo computacional para la indicación de quimioterapia en cáncer de mama / Evaluation of a computer program in use of adjuvant chemotherapy in early breast cancer

El cáncer de mama es la segunda causa de muerte por cáncer en mujeres en Chile. El tratamiento adyuvante con quimioterapia ha demostrado disminuir la recurrencia y muerte por la enfermedad. La recomendación de usar adyuvancia en un paciente individual es compleja y depende de la evaluación del riesgo de recaída, muerte y condición del enfermo. Adjuvant! es un modelo computacional útil en la predicción de la sobrevida y beneficio de la terapia adyuvante en pacientes con cáncer de mama. El modelo Adjuvant! se estudió en nuestra población de pacientes para conocer el beneficio estimado de la quimioterapia y la relación con su prescripción. Se aplicó Adjuvant! a 125 pacientes con cáncer de mama precoz (T1N0M0) tratadas con cirugía conservadora y radioterapia, 20 (16%) recibieron quimioterapia adyuvante. Según el modelo, el beneficio absoluto en sobrevida global a 10 años con quimioterapia en este grupo es de 1.3% (0,1-11,1%) y la reducción absoluta en el riesgo de recurrencia de 6.45% (0.4-20%). Un 25% de pacientes obtendría un beneficio en sobrevida global mayor del 2% y un 58,4% (73/125) mayor al 1%. De las pacientes de nuestra serie que recibieron quimioterapia un 50% (10/20) recibirían un beneficio esperado en sobrevida global menor al 2%. La mediana de beneficio del tratamiento combinado quimioterapia / hormonoterapia en la sobrevida global es de 1,8% (2-11,1) y en la sobrevida libre de enfermedad de 10.5% (1-25,6%). En estudios clásicos, al consultar a pacientes ya tratadas, más del 50% usarían nuevamente quimioterapia por un beneficio absoluto menor al 1%.

Breast cancer is the second cause of female death in Chile. Adjuvant chemotherapy has reduced breast cancer recurrence and death. The decision to use adjuvant chemotherapy for a specific patient is complex and must consider the general condition of the patient and its risks of recurrence and death. The computer model called Adjuvant! was designed for breast cancer to predict survival and determine the benefit of adjuvant chemotherapy. The Adjuvant! model was calculated for our population of breast cancer patients to determine the predicted benefit of chemotherapy and compare it with the actual indication. The Adjuvant model was applied to 125 patients with early breast cancer, (T1N0M0), treated with breast conserving surgery and post operative radiotherapy. Adjuvant chemotherapy was use in 20 patients (16%). According to the predictive model the absolute 10-year survival benefit with chemotherapy is 1.3% (0.1-11.1%) and the absolute recurrence risk reduction is 6.45% (0.4-20%). For 25% of the patients chemotherapy would result in an overall survival benefit larger than 2% and for 58.4% (73/125) larger than 1%. In our series 50% (10/20) received chemotherapy with a predicted overall survival benefit less than 2%. The median benefit with the combination of chemotherapy and hormonal therapy in overall survival was 1.8% (0.2-11.1) and in disease free survival was 10.5% (1-25.6%). Reports from the literature indicate that more that 50% of patients treated with chemotherapy would agree to receive it again for a benefit less than 1%.

¿Es curable el cáncer de mama en etapa precoz?: Resultados del tratamiento combinado con cirugía, radioterapia y quimioterapia / Treatment results of early breast cancer: A retrospective review

Background: Breast cancer will develop in one out of ten women during their lifetime. Early diagnosis has increased in recent years. Aim: To describe a population of women with breast cancer stage T1N0M0. To analyze radiation therapy toxicity and to evaluate treatment results. Material and methods: Retrospective review of the medical records of 125 women (aged 35 to 80 years) with breast cancer T1N0M0, that were treated between January 1997 and May 2004, with breast conserving surgery and postoperative radiation therapy at an oncology center. Patients lost from follow up were contacted by telephone. Results: An abnormal screening mammography was the reason for consult in 62 percent of cases. The average tumor size was 11.6 mm. Tumors detected with screening mammogram were smaller than those detected on physical exam. The most common radiotherapy toxicity was erithema, which was severe in 2.5 percent of cases. No patient had to stop the radiation treatment due to toxicity. One patient developed arm edema. Tamoxifen was prescribed for 5 years to 80 percent of patients and 17 patients received chemotherapy. After an average follow up of 40 months, no patient has developed local breast relapse, three patients developed contralateral breast cancer and three developed distant metastasis. Two patients died from breast cancer. Disease free survival was 95 percent. Conclusions: Radiotherapy was well tolerated and had excellent local control. Screening mammography detects small tumors. Survival is excellent for early stage breast cancer.

Resultados a largo plazo del tratamiento con quimioterapia y radioterapia en linfoma no Hodgking localizado, de grados intermedio y alto / Long term results for intermediate and high grade localized non Hodgkin lymphoma, treated with chemotherapy and radiotherapy

Background: Treatment of intermediate and high grade non-Hodgkin lymphoma (NHL) includes chemotherapy with or without radiotherapy, depending on the clinical stage. The standard treatment for advanced NHL is 8 cycles of combined chemotherapy, cyclophosphamide, adriamicin, vincristine and prednisone (CHOP). Patients presenting with localized disease are treated with fewer chemotherapy cycles and involved field radiotherapy, with good results. Aim: To evaluate the treatment results including overall survival (OS) and event-free survival (EFS) in localized aggressive NHL patients treated at the Pontificia Universidad Católica de Chile, Clinical Hospital. Patients and Methods: Retrospective analysis of all patients with Ann Arbor stages I and II referred to the hematology and radiotherapy clinic between 1998 and 2003. OS and EFS analysis was made according to the Kaplan and Meier method. Log-rank and Cox methods were used for univariate and multivariate analyses, respectively. Chemotherapy and radiotherapy toxicities were scored according to World Health Organization (WHO) and Radiation Therapy Oncology Group (RTOG) scales, respectively. Results: 39 patients (20 men), aged between 20 to 85 years, were the source for this study. The average follow-up was 51 months (range 6-115). The 5 years OS and EFS were 72,4 percent and 63,3 percent, respectively. On univariate analysis, age over 60 was the only variable that affected negatively OS and EFS. Acute toxicity caused by chemotherapy and radiotherapy was uncommon. Conclusions: Age over 60 was the only independent variable associated with poor prognosis. The number of chemotherapy cycles and the drug combination did not influence the results. These results support the usefullness of a shortened chemotherapy regimen plus involved field radiotherapy.

[Long term results for intermediate and high grade localized non Hodgkin lymphoma, treated with chemotherapy and radiotherapy]. / Resultados a largo plazo del tratamiento con quimioterapia y radioterapia en linfoma no Hodgking localizado, de grados intermedio y alto.

BACKGROUND: Treatment of intermediate and high grade non-Hodgkin lymphoma (NHL) includes chemotherapy with or without radiotherapy, depending on the clinical stage. The standard treatment for advanced NHL is 8 cycles of combined chemotherapy, cyclophosphamide, adriamycin, vincristine and prednisone (CHOP). Patients presenting with localized disease are treated with fewer chemotherapy cycles and involved field radiotherapy, with good results. AIM: To evaluate the treatment results including overall survival (OS) and event-free survival (EFS) in localized aggressive NHL patients treated at the Pontificia Universidad Católica de Chile, Clinical Hospital. PATIENTS AND METHODS: Retrospective analysis of all patients with Ann Arbor stages I and II referred to the hematology and radiotherapy clinic between 1998 and 2003. OS and EFS analysis was made according to the Kaplan and Meier method. Log-rank and Cox methods were used for univariate and multivariate analyses, respectively. Chemotherapy and radiotherapy toxicities were scored according to World Health Organization (WHO) and Radiation Therapy Oncology Group (RTOG) scales, respectively. RESULTS: 39 patients (20 men), aged between 20 to 85 years, were the source for this study. The average follow-up was 51 months (range 6-115). The 5 years OS and EFS were 72,4% and 63,3%, respectively. On univariate analysis, age over 60 was the only variable that affected negatively OS and EFS. Acute toxicity caused by chemotherapy and radiotherapy was uncommon. CONCLUSIONS: Age over 60 was the only independent variable associated with poor prognosis. The number of chemotherapy cycles and the drug combination did not influence the results. These results support the usefulness of a shortened chemotherapy regimen plus involved field radiotherapy.