Trastornos respiratorios del sueño en pediatría: avances en tiempos pandémicos / Sleep-disordered breathing in pediatrics: advances in pandemic times

Los avances en medicina del sueño son de gran relevancia para enfrentar adecuadamente los trastornos del sueño en niños y adolescentes, procurando mitigar sus efectos multisistémicos y llevando a la práctica conductas de un mejor estándar. Este artículo de revisión se enfoca en mostrar los principales avances sobre trastornos respiratorios del sueño, refiriéndonos a las experiencias publicadas durante estos años de pandemia sobre avances epidemiológicos, consecuencias cardiovasculares, lectura de estudios de sueño y estudios domiciliarios; finalmente aspectos sobre tratamiento quirúrgico versus conservador, soporte ventilatorio y dispositivos autorregularles ambulatorios para titulación.

Advances in sleep medicine are of great relevance to adequately address sleep disorders in children and adolescents, seeking to reduce their multisystem effects and implementing better standard behaviors. This review article focuses on showing the main advances on sleep-disordered breathing, referring to the experiences published during these pandemic years on epidemiological advances, cardiovascular consequences, reading sleep studies and home studies; finally, aspects of surgical versus conservative treatment, ventilatory support and ambulatory self-regulating devices for titration.

Perfil de incidencia de VIH en embarazadas atendidas en el Instituto Nacional Materno Perinatal de Lima, Perú / Incidence rate of HIV in pregnant women attended at the Instituto Nacional Materno Perinatal of Lima, Perú

Resumen OBJETIVO Determinar la incidencia de la infección por VIH en mujeres embarazadas atendidas en el Instituto Nacional Materno Perinatal de Lima, Perú (2007-2016). MATERIAL Y MÉTODOS Estudio observacional, descriptivo y retrospectivo. Revisión de los resultados de los exámenes diagnósticos de VIH de mujeres embarazadas efectuados según la normativa nacional vigente que incluye las pruebas de tamizaje (inmunocromatografía o ELISA). Los reportes positivos se corroboran con exámenes confirmatorios (inmunofluorescencia indirecta y western blot). Determinación de la incidencia de VIH de acuerdo con la tendencia anual; aplicación de la correlación de Pearson y prueba de χ2 para comparar las características del perfil de incidencia. RESULTADOS Se tamizaron 113,258 mujeres embarazadas y la incidencia obtenida fue de 2.9 por cada mil. La tendencia anual fue errática, excepto entre 2014 y 2016 años en los que se advirtió una tendencia a disminuir. Solo se tamizó a 22.7% de las parejas masculinas en quienes la seroconcordancia fue 10.3%, y la serodiscordancia 12.4%. La frecuencia de seroconcordancia se correlacionó directamente con el porcentaje de parejas tamizadas e inversamente con la frecuencia de VIH (p<0.05). La condición de convivencia o madre soltera se asoció con mayor frecuencia a la falta de tamizaje de la pareja (p<0.001). CONCLUSIONES La incidencia de VIH confirmado fue errática (2007-2016). Deben proponerse estrategias para incrementar el tamizaje en las parejas de las embarazadas infectadas, teniendo en cuenta la alta frecuencia de inestabilidad de ese tipo de unión.

Abstract OBJECTIVE To determine the incidence of HIV infection in pregnant women treated at the National Maternal and Perinatal Institute (Lima, Peru), between 2007-2016. MATERIAL AND METHODS Observational, descriptive and retrospective study. The results of the diagnostic tests of HIV in pregnant women were reviewed, carried out according to current national regulations, which includes the screening tests (immunochromatography and / or ELISA), which in case of being reactive were corroborated by confirmatory tests (indirect immunofluorescence and Western Blot). The incidence of HIV was measured according to the annual trend, and the Pearson correlation and χ2 test were applied to compare the characteristics of the incidence profile. RESULTS 113,258 pregnant women were screened, obtaining an incidence of 2.91 per thousand pregnant women, the annual trend was erratic, except between 2014 and 2016 where there was a tendency to decrease. Only 22.73% of the couples of the pregnant women were screened, the seroconcordance was 10.3%, and the serodiscordance was 12.42%. The frequency of seroconcordance correlated directly with the percentage of sifted couples and inversely with the frequency of HIV (p <0.05). The condition of coexistence or single mother was associated more frequently with the lack of screening of the couple (p <0.001). CONCLUSIONS The confirmed incidence of HIV was erratic (2007-2016). Strategies should be elaborated to increase the screening in the pairs of the infected pregnant women, taking into account the high frequency of the instability of said union.

Conocimiento, aceptación y uso de medicina tradicional peruana y de medicina alternativa/complementaria en usuarios de consulta externa en Lima Metropolitana / Knowdlege, aceptation and use of peruvian traditional medicine and complementary/alternative medicine in users from outpatient services in Lima Metropolitana

Objetivo: Determinar los conocimientos, aceptación y uso de la Medicina Tradicional Peruana y la Medicina Alternativa/Complementaria en usuarios de consulta externa de en establecimientos de salud de Lima Metropolitana. Materiales y Métodos: Se realizó una encuesta validada en 351 usuarios de consulta externa de ocho establecimientos de salud pertenecientes al Ministerio de Salud (MINSA) y Seguro Social de Salud (EsSalud) donde se evaluaron los patrones de uso, conocimiento y aceptación de terapias de Medicina Tradicional Peruana (MTC) y Medicina Complementaria/Alternativa (MAC). Resultados: La terapia de MTP más conocida, aceptada y usada fue la pasada de huevo (71.5%, 67.5% y 58.1%) mientras que en el caso de las terapias de MAC fue la fitoterapia (63.8%, 72.1% y 59.5%), La MTP mayormente fue usada solo 1-2 veces y un 29.6% refirió el uso de MAC, como la fitoterapia, en todos sus episodios de enfermedad. La razón más frecuente de aceptación es la "integración a la medicina convencional" (20.5% en MTP y 29.9% en MAC) y las de no aceptación fueron el no tener bases científicas (14.8% en MTP) o no estar reconocida legalmente (29.9% en MAC). Conclusión: La terapia de MTP más conocida, aceptada y usada fue la pasada de huevo, mientras que en el caso de MAC fue la fitoterapia. Las terapias de MTP suelen ser menos usadas que las terapias MAC por los encuestados. Estos procedimientos suelen ser realizados en el domicilio del paciente y son aceptados por la posibilidad de integración con la medicina convencional.

Tuberculosis, los errores que cometemos: experiencia del Hospital San Juan de Dios / Tuberculosis, our mistakes: the experience at San Juan de Dios Hospital

Tuberculosis is an infectious disease that in Chile is far from eradicated. To ask what improvements we could make, we must recognize from our experience at San Juan de Dios Hospital, the major mistakes which many of us do, both in the diagnosis and management of the disease. Possibly the most important, common and serious mistake, is to believe that tuberculosis is eradicated, because if we believe it does no longer exists, then we do not seek it, and leave undiagnosed infectious cases, keeping the reservoirs of the disease.

La tuberculosis es una enfermedad infecciosa que en Chile está lejos de ser eliminada. Para plantear qué mejoras podríamos realizar para su control es necesario conocer los principales errores que según nuestra experiencia, en el Hospital San Juan de Dios, muchos de nosotros cometemos, tanto en el diagnóstico como en el manejo de la enfermedad. El más común y grave, posiblemente sea el de creer que la tuberculosis está erradicada, porque si creemos que ya no existe, no la buscaremos y dejaremos casos sin diagnosticar, manteniendo los reservorios que trasmiten la enfermedad.

Estilo de apego, riesgo relacional y depresión en gestantes adolescentes de los Consultorios de Atención Primaria de Valparaíso / Attachment, relational risk and depression in pregnant adolescents of the Primary Health Care System of Valparaiso

La Gestación adolescente puede traer consecuencias negativas para la díada. Su aparición, podría relacionarse con el estilo de apego de la joven madre, y a su vez dicho patrón relacionarse con la presencia de depresión prenatal y de dificultad en la vinculación con su bebé. Estudio tipo caso-control cuyo objetivo fue comparar el estilo de apego de las gestantes adolescentes versus adultas y su relación con el riesgo relacional de la díada y sintomatología depresiva en ambos grupos. Se les aplicó Escala Edinburgo, Instrumento De Lazos Parentales y Escala De Riesgo Relacional Prenatal. La muestra estuvo compuesta por 29 casos y 29 controles. Las gestantes adolescentes, resultaron tener menor porcentaje de apego seguro con su figura de apego primaria (17,2% v/s 44,8%), mayor riesgo de depresión prenatal (41,33% v/s 17,2%) y alto riesgo relacional (51,7% v/s 24%), todas diferencias estadísticamente significativas. Se justifica la necesidad de diseñar intervenciones preventivas enfocadas en minimizar estos riesgos. Palabras Claves: Apego, Gestación Adolescente, depresión prenatal, riesgo relacional.

Adolescent pregnancy can have negative consequences for the dyad. Its appearance could be related to the attachment style of the young mother, and that pattern be related to the presence of prenatal depression and difficulty in bonding with their baby.This is a case-control study where the aim was to compare the style of attachment of adolescents versus adult pregnant women and their relationship with the relational risk of the dyad and depressive symptoms in both groups. We applied the Edinburg Scale, the Parental Bonding Instrument and the Prenatal Relational Risk Scale. The sample consisted of 29 cases and 29 controls. Pregnant teenagers were found to have a lower percentage of secure attachment with their primary attachment figure (17.2% v / s 44.8%), increased risk of prenatal depression (41.33% v / s 17.2%) and high relational risk (51.7% v / s 24%). All differences were statistically significant. The need to design preventive interventions focused on minimizing these risks are justified.Keywords: Attachment, Adolescent Pregnancy, Prenatal Depression, Relational Risk.

Anomalías de forma y número en dentición temporal en una población Mexicana / Dental anomalies of form and number in primary dentition in a Mexican population

Determinar la frecuencia y distribución de las anomalías de forma y de número en dentición temporal. Material y Métodos: Estudio retro-prolectivo, transversal y descriptivo. Muestreo probabilístico por conveniencia estratificado por género. Se revisaron 1568 expedientes de pacientes que acudieron a la Clínica de Estomatología Pediátrica de la FEBUAP, durante el periodo 2012 a 2014, se incluyeron 720 expedientes (321 niñas y 399 niños) de 1 a 10 años, que presentaron estudios radiográficos completos, nítidos, con presencia de anomalías de forma o número, el estudio fue dividido en pacientes activos e inactivos. Para los inactivos se tomaron fotografías de las radiografías con presencia de anomalías de forma y /o número. En el caso de los activos, se realizó una entrevista con alguno de los padres, se solicitó autorización bajo consentimiento informado, asentimiento por parte del niño para realizar la exploración clínica y la toma de fotografías introrales. Resultados: En total 63 niños tuvieron anomalías (17 niñas y 46 niños). La prevalencia total de las anomalías dentarias fue de 9%, de los cuales e13,1 % fueron (dientes fusionados y geminados), 1,1 % (agenesias) y 1,9% (supernumerarios), 1,3% (raíces supernumerarias), 0,27% (macrodoncia), 0,11 % (microdoncia) y finalmente el 0,27% correspondió a (talón cuspideo). Conclusiones: A pesar de que la prevalencia de estas anomalías no es alta, es importante el examen radiográfico de rutina para realizar un diagnóstico temprano y así aplicar las medidas preventivas correctas, para establecer el mejor plan de tratamiento...

To determine the frequency and distribution of dental anomalies of shape and number in primary dentition. Methods: The study is retro-prolective, cross-sectional and descriptive. The sample was probabilistic, stratified for convenience by gender. The clinical record of 1,568 patients was reviewed. These patients attended the Clinic of Pediatric Dentistry of FEBUAP during the period of 2012- 2014, only 720 records of patients were included in the study (321 girls and 399 boys) between the ages of 1-10 years old, who provided complete, crisp radiographic studies with the presence of dental anomalies of shape or number, the study was divided into active and inactive patients. For inactive patients, photographs of x-rays with dental anomalies of shape and/ or number were taken. For cases with active patients, an interview with one of the parents was conducted and authorization with informed consent was requested, also the child agreed to do a clinical examination and take intra oral photographs. Results: A total of 63 children had anomalies (17 girls and 46 boys). The total prevalence of dental anomalies was 9%, of which 3.1 % were (fused and geminated teeth), 1.1% (agenesis) and 1.9% (supernumerary), 1.3% (supernumerary roots), 0.27% (macrodontia), 0.11% (microdontia), and finally 0.27% corresponded to (talon cusp). Conclusions: Although the prevalence of these anomalies is not high, it is important to do a routine radiographic examination for early diagnosis and accordingly apply the correct preventive measures to establish the best treatment plan...

Transfusion-Related Acute Lung Injured (TRALI): Current Concepts.

Transfusion-related acute lung injury (TRALI) is a life-threatening intervention that develops within 6 hours of transfusion of one or more units of blood, and is an important cause of morbidity and mortality resulting from transfusion. It is necessary to dismiss other causes of acute lung injury (ALI), like sepsis, acute cardiogenic edema, acute respiratory distress syndrome (ARDS) or bacterial infection. There are two mechanisms that lead to the development of this syndrome: immune-mediated and no immune- mediated TRALI. A common theme among the experimental TRALI models is the central importance of neutrophils in mediating the early immune response, and lung vascular injury. Central clinical symptoms are dyspnea, tachypnea, tachycardia, cyanosis and pulmonary secretions, altogether with other hemodynamic alterations, such as hypotension and fever. Complementary to these clinical findings, long-term validated animal models for TRALI should allow the determination of the cellular targets for TRALI-inducing alloantibodies as well as delineation of the underlying pathogenic molecular mechanisms, and key molecular mediators of the pathology. Diagnostic criteria have been established and preventive measures have been implemented. These actions have contributed to the reduction in the overallnumber of fatalities. However, TRALI still remains a clinical problem. Any complication suspected of TRALI should immediately be reported.

Results of induction chemotherapy in children older than 18 months with stage-4 neuroblastoma treated with an adaptive-to-response modified N7 protocol (mN7).

PURPOSE: We report the response rate in children older than 18 months with stage 4 Neuroblastoma, using a modified dose-intensive, response-adaptive, induction mN7 protocol. METHODS: From 2005 to 2012, 24 patients were treated with the mN7 protocol. Phase 1 included five MSKCC N7 cycles and surgery and two high-dose cyclophosphamide-topotecan (HD-CT) cycles for those who did not achieve complete remission (CR) and negative bone marrow (BM) minimal residual disease (MRD) status (CR+MRD-). Phase 2 consisted of myeloablative doses of topotecan, thiotepa and carboplatin plus hyperfractionated RT. Phase 3 included isotretinoin and 3F8 immunotherapy plus GM-CSF. BM MRD was monitored using GD2 synthase, PHOX2B and cyclin D1 mRNAs. RESULTS: After 3 cycles, all patients showed BM complete histological clearance and 6 (25 %) were MRD-. Twenty of 21 s-look surgeries achieved macroscopic complete resection. After 5 cycles and surgery, (123)I-MIBG scan was negative in 15 (62.5 %) cases, BM disease by histology was negative in 23 (96 %) and 10 (42 %) patients were MRD-. Twelve (50 %) pts were in CR, 2 in very good partial response (VGPR), 9 partial response (PR) and one had progressive disease. With 2 HD-CT extra cycles, 17 (71 %) pts achieved CR+MRD- status moving to phase 2. Overall and event-free survival at 3 years for the 17 patients who achieved CR+MRD- is 65 and 53 %, respectively, median follow-up 47 months. Seven (29 %) patients never achieved CR+MRD-. Univariate Cox regression analysis shows CR+MRD- status after mN7 induction as the only statistically significant prognostic factor to predict overall survival. CONCLUSIONS: mN7 induction regimen produced a CR+MRD- rate of 71 %. CR+MRD- status following induction was the only predictive marker of long-term survival.

Citotoxicidad de ciclozonarona sobre líneas celulares de fibroblastos y de cáncer de próstata / Cytotoxicity of Cyclozonarone on fibroblasts and prostate cancer cellular lines

INTRODUCCIÓN: El cáncer es una importante causa de mortalidad a nivel mundial, lo que ha motivado la búsqueda de compuestos que ayuden a su remisión, incluyendo compuestos naturales. En este contexto, las sesquiterpén quinonas son evaluadas como posibles sustancias antitumorales por sus propiedades citotóxicas. Una de ellas es Ciclozonarona...

INTRODUCTION: Cancer is a major cause of death in the world, which has motivated the search of compounds that could help to its remission, including natural compound. In this context sesquiterpene quinones are evaluated as possible antitumor substances for its cytotoxic properties, one of them is Ciclozonarone...

Alteraciones del espermiograma en pacientes asistidos en la Unidad de Biología de la Reproducción de la Universidad de Chile / Alterations in the semen analysis of patients attending the reproductive biology unit at the University of Chile

En Chile, 10 a 15 por ciento de las parejas son consideradas como infértiles y el factor masculino es responsable en un 50 por ciento de los casos. El espermiograma, es un examen fundamental para el diagnóstico inicial de parejas infértiles. Objetivo: Determinar cambios en cuatro parámetros del espermiograma de mayor valor diagnóstico, según edad, estableciendo el parámetro alterado de mayor frecuencia. Métodos: Se realizo un estudio descriptivo retrospectivo de una muestra de 100 pacientes atendidos por problemas de fertilidad entre los años 2004 y 2009, clasificándolos en cuatro grupos etarios. Resultados: Al evaluar la concentración espermática, el 33 por ciento presenta: 5 baja concentración. El 86 por ciento de los pacientes presento astenozoospermia. El 81 por ciento de los pacientes presento anormalidad en la morfología espermática. La viabilidad espermática fue anormal en el 8 por ciento de los pacientes, siendo significativamente más alto en el grupo etario de mayor edad. Conclusiones: Los parámetros estudiados muestran un alto porcentaje de anormalidad en la población en estudio. Al comparar entre grupos, el grupo de mayor edad (sobre los 47 &los) presenta un aumento significativo del- porcentaje de alteraciones en morfología, motilidad y viabilidad respecto a los otros grupos etarios, estableciéndose la edad como un factor negativo en la calidad espermática. La movilidad corresponde al parámetro mas frecuentemente alterado seguido por la morfología espermática a medida que el varón consultante envejece.

In Chile, 10 to 15 percent of the couples are considered as infertile. Since the male factor is responsible of 50 percent of the cases, spermogram is an essential test for initial diagnosis of the infertile couple. Objective: To analyze the frequency of change in four spermogram parameters -according to age- to determine their diagnostic value. Method: A descriptive retrospective study of spermogram data from 100 patients -subdivided in four age groups- analyzed in our Unit for fertility problems between 2004 and 2009 was performed. Results: In sperm count, 33 percenr showed an abnormally low concentration. An 86 percent of the patients has astenozoospermia. 81 percent of the patients showed abnormal sperm morphology. Sperm viability was subnormal in 8 percent of the patients, being significantly higher in the oldest group. Conclusions: The seminal parameters analyzed revealed a high percentage of anomalies in the studied population. The oldest group had significant percentages of anomalies in sperm motility, morphology and viability, thus corroborating that age is a negative factor that affects semen quality. Sperm motility was the most frequently altered parameter followed by sperm morphology in the population under study.

Acantosis nigricans como manifestación paraneoplástica 7 años antes del diagnóstico de un linfoma no hodgkin: reporte de un caso y revisión de la literatura / Acanthosis nigricans as paraneoplastic manifestation 7 years before of the diagnostic of no hodgkin lymphoma: report of a case and review of literature

Introducción: una amplia variedad de signos cutáneos han sido asociados a neoplasia oculta, los que pueden presentarse precozmente y constituir el primer signo de la enfermedad. Las dermatosis paraneoplásicas se manifiestan por la acción de moléculas específicas producidas por células tumorales, ó por la depleción de sustancias específicas causado por éstas últimas. Presentación Clínica: paciente de 66 años de edad hiperpigmentación cutánea en cara y hemitórax superior de siete años de evolución asociado a puritos intermitente. Ingresó a la unidad de urgencias del Hospital Dr. Gustavo Fricke por cuadro agudo con sospecha de trombosis venosa profunda, destacando al examen físico múltiples adenopatías cervicales y retroauriculares, y una masa hipogástrica de 15x15cms. El estudio de imagen reveló múltiples masas tumorales en tórax, abdomen y pelvis, con biopsia ganglionar compatible con linfoma no Hodgkin variante folicular. Discusión y Conclusión: las afecciones de la piel pueden ser manifestaciones precoces de procesos malignos subyacentes, por lo que es fundamental enfrentar al paciente de manera integral, haciendo uso acabado de las herramientas clínicas disponibles para realizar un diagnóstico etiológico precoz.

High-sensitivity C-reactive protein and liver enzymes in individuals with Metabolic Syndrome in Talca, Chile.

Metabolic syndrome (MS) is a core set of disorders, including abdominal obesity, dyslipidemia, hypertension and hypertriglyceridemia that together predict the development of diabetes type 2 and cardiovascular disease. This study investigated the relationship between liver enzyme levels and high-sensitivity C-reactive protein (hs-CRP) in subjects with and without MS. Alanine-aminotransferase (ALAT), aspartate-aminotransferase (ASAT), γ-glutamyl transferase (GGT) and hs-CRP were measured in 510 subjects, aged 40 to 65 years old. Patients were selected from 1007 subjects from the Research Program for Cardiovascular Disease Risk Factors in Talca, Chile. Results showed that women with MS presented higher liver enzyme levels than those who did not have MS. This was not observed in male patients for the enzymes ALAT and ASAT. However, GGT and hs-PCR levels were higher in male and female patients with MS than in those without MS. In conclusion, it is important to search for the presence of MS when diagnosing fatty liver. Moreover, the presence of liver disease in patients with MS should be further investigated.

A high fat diet in CF-1 mice: An experimental model for metabolic syndrome.

Cardiovascular diseases account for the majority of deaths worldwide. Many of their risk factors have been identified but, for their continued study, research centering on new murine models is of interest. In this study, a high fat diet (HFD) and a normal diet (ND) (25 and 4.4% fat, respectively) were tested over a 40-day period to induce the same metabolic alterations in CF-1 mice in two separate experiments. The parameters measured for these effects corresponded to the weight of ingested food and water, to the weight of the mice and their selected organs (adipose tissue, gastrocnemius, liver and heart), to their biochemical profile (glycemia, blood uric nitrogen, uric acid, triglycerides, cholesterol, proteins and albumin) and to the percentage of fat in their livers. The biochemical profile of the CF-1 mice fed a diet high in fat but balanced in proteins (16.9%) showed statistically significant increases in glycemia, cholesterol and triglyceride levels. A statistically significant increase in the weight of adipose tissue was also observed. No statistically significant differences were observed in the muscular mass of either of the groups of mice, but a high percentage of fat was found in the liver. The results lead to the conclusion that CF-1 mice fed a HFD develop metabolic alterations that correspond to an equivalent metabolic syndrome. This is important in the evaluation of the effects of various interventions, such as food, exercise and molecules, on metabolic alterations in mice induced by the intake of a HFD.

Estudio histomorfológico comparativo del endometrio de ovejas prepúberes de razas de distinta prolificidad / Comparative histomorphological study of prepuberal ewe endometrio of different prolificity races

El objetivo del presente estudio fue sentar bases morfológicas para realizar análisis inmunocitoquímicos e hibridación in situ de la presencia y distribución de receptores de estrógeno y progesterona en ovejas de distinta prolificidad y en distintos planos de nutrición, centrando nuestro interés en el endometrio por su relevancia en los mecanismos reproductivos. Se utilizaron ovejas prepúberes Romney Mash de alta prolificidad (n=2) y Araucanas de prolificidad standard(n=2) de las cuales inmediatamente después del sacrificio se tomaron muestras para estudio histológico del útero, oviducto y ovario. Para el análisis histológico los cortes fueron teñidos con Hematoxilina-Eosina, Van Giesson, Arteta y Ácido Periódico de Schiff (P.A.S.). Los resultados mostraron en las dos razas adecuado desarrollo endometrial, con ßreas carunculares e intercarunculares glandulares bien desarrolladas indispensables estas últimas para una buena implantación y crecimiento del embrión. Las glándulas, numerosas, eran tubulares, tortuosas, algo ramificadas y se extendían hasta el miometrio. No se observaron diferencias histológicas significativas entre ambas razas ni cambios morfológicos durante el transcurso de los días 93 al día 117 post natal, siendo su aspecto similar al de endometrio de la oveja adulta.

The aim of the present study was to sit morphological bases for the inmumocitochemical and hybridazion in situ study of the presence and distribution of estrogen and progesterone receptors in sheep of different prolificity and in different nutrition plane, centering our interest in the endometrium for its relevance in the reproductive mechanisms. We used sheep prepuberal Romney Mash of high prolificity (n=2) and Araucanian of standard prolificity(n=2) Immediately after slaughter uterine tissue was taken for histhological study from uteri , oviduct and ovary. Cross sections were stained with Hematoxilina-eosina, Van Giesson, Arteta and Periodic Acid of Schiff (P.A.S.). The results showed in both races a good endometrial development, with caruncular and glandular intercaruncular glandular areas well defined, the later necessary for embryo implantation and growth the numerous, tubular, coiled, glands, extend to the miometrium. No significant histological differences were observed between both races neither morphological changes between days 93 to 117 of post natal life, being their aspect similar to the endometrium of mature sheep

High resolution chromosome 3p, 8p, 9q and 22q allelotyping analysis in the pathogenesis of gallbladder carcinoma.

Our recent genome-wide allelotyping analysis of gallbladder carcinoma identified 3p, 8p, 9q and 22q as chromosomal regions with frequent loss of heterozygosity. The present study was undertaken to more precisely identify the presence and location of regions of frequent allele loss involving those chromosomes in gallbladder carcinoma. Microdissected tissue from 24 gallbladder carcinoma were analysed for PCR-based loss of heterozygosity using 81 microsatellite markers spanning chromosome 3p (n=26), 8p (n=14), 9q (n=29) and 22q (n=12) regions. We also studied the role of those allele losses in gallbladder carcinoma pathogenesis by examining 45 microdissected normal and dysplastic gallbladder epithelia accompanying gallbladder carcinoma, using 17 microsatellite markers. Overall frequencies of loss of heterozygosity at 3p (100%), 8p (100%), 9q (88%), and 22q (92%) sites were very high in gallbladder carcinoma, and we identified 13 distinct regions undergoing frequent loss of heterozygosity in tumours. Allele losses were frequently detected in normal and dysplastic gallbladder epithelia. There was a progressive increase of the overall loss of heterozygosity frequency with increasing severity of histopathological changes. Allele losses were not random and followed a sequence. This study refines several distinct chromosome 3p, 8p, 9q and 22q regions undergoing frequent allele loss in gallbladder carcinoma that will aid in the positional identification of tumour suppressor genes involved in gallbladder carcinoma pathogenesis.

Laparoscopic pericystectomy for liver hydatid cysts.

BACKGROUND: The laparoscopic approach for managing of liver echinococcosis is a controversial issue because of scarce experience worldwide. The aim of this report is to describe the technical details of our laparoscopic method and present our results. METHODS: Consecutive cases of liver echinococcosis managed by laparoscopic surgery are reported. Thoracic x-ray and abdominal ultrasound had been performed previously. The following aspects were considered as selection criteria: unique cyst located in segments III, IV, V, VI, and VIII; diameter less than 7 cm; and no evidence of infection or calcification. An evacuating puncture was performed, germinative membrane removed, and pericystectomy performed, which extirpated the pericystic structure with the surrounding liver parenchyma. Specimens were removed in a plastic bag through one of the ports. Surgical morbidity, hospital stay, time until return to work, and evidences of hydatid recurrence were measured. RESULTS: Surgery was performed on eight patients (5 women and 3 men) with a mean age of 44.9 years (range, 22-83 years) who had a liver hydatid cyst with a mean diameter of 6.6 cm (range, 5-7 cm). During a mean follow-up period of 30 months (range, 23-44 months), no morbidity or hydatid recurrence were verified. Hospital stay was 2 days in all cases, and return to work was within 15 days. CONCLUSION: This laparoscopic technique, applied with selective criteria, can be a useful alternative for treating patients with liver hydatidosis because its results are comparable with those for open surgery studies involving similar follow-up time.

Molecular descriptor based on a molar refractivity partition using Randic-type graph-theoretical invariant.

PURPOSE: Development of a novel semi-empirical descriptor (MR(chi) for molecular modelling. METHOD: The index is based on a molar refractivity partition using Randictype graph-theoretical invariant. RESULTS: This hybrid index describes not only the London dispersive forces in a ligand fragment related to the molar refractivity but also structural features of the molecule It is also applicable in Quantitative Structure-Activity Relationship (QSAR) and Quantitative Structure-Property Relationship (QSPR) studies. CONCLUSIONS: The method is convenient and can discriminate between isomers.

[Cholangiohydatidosis. An evolutive complication of hepatic hydatidosis]. / Colangiohidatidosis. Una complicación evolutiva de la hidatidosis hepática.

Hydatidosis is and endemic disease in the south of Chile, especially in Region IX where remain rates of high prevalence. Cholangiohydatidosis is an infrequent complication of liver hydatidosis. The objective of this paper is to describe clinical features of a series of patients with cholangiohydatidosis. Series of cases of cholangiohydatidosis treated consecutively and the corresponding follow-up is reported. Clinical, laboratory and images characteristics are described. Descriptive statistic was used its incidence was calculated. In the studied period, 13 patients with cholangiohydatidosis were recruited, 9 men (69.2%) and 4 women (30.7%). Observed laboratory abnormalities were an increment of leukocytes in 8 patients (61.5%) and hepatic cholestasis with hepatocyte signs of cytolysis in 11 patients (84.6%). Choledocus diameter average measured by ultrasonography was 24.7 mm. All the patients had at least one liver cyst whose diameter average was of 12.1 cm. At surgery, evidence of biliary communications was detected in all patients and biliary decompression was carried out through a choledocostomy in 12 patients (92.3%) and by choledocoduodenal anastomoses in one case (7.7%). With a mean follow-up of 38.7 months morbility was 23% and mortality 7.7%. Accumulated incidence of this entity was of 0.07 cases in 5 years. Cholangiohydatidosis is an uncommon complication of liver hydatidosis that presents considerable morbidity and mortality rates.

Rapid surveys for program evaluation: design and implementation of an experiment in Ecuador.

This paper presents details from the field test of two rapid surveys in Ecuador in 1995. It focuses on how the surveys were designed and implemented, including descriptions of the sampling procedures, the preparation and use of preprogrammed palmtop computers for data entry, the selection criteria for the interviewing team, and how the training was designed. Lessons are drawn that will assist health professionals plan and carry out better rapid data collection in the future. The objective of the study was to evaluate the reliability and validity of data gathered during the rapid surveys as compared with a recent "gold standard" national survey. A two-way factorial design was used to control for differences in sampling (probability versus quasi-probability) and methods of data collection (paper versus palmtop computer). Few differences were detected between the surveys done on palmtops as compared to paper ones, but urban and rural differentials in contraceptive use were less pronounced in the rapid surveys than in the earlier, national survey. This suggests that caution should be exercised in interpreting the disaggregated data in these rapid surveys. In-depth interviews revealed two features of the rapid surveys that were especially popular: the palmtops for their speed of data entry, and the short questionnaire for its "low impact" on a respondent's time. The common belief that computers would disturb respondents was not found to be the case. Even with no computer experience, the interviewers rapidly mastered the new technology.

Prevalence of anti-R-13 antibodies in human Trypanosoma cruzi infection.

Infection with Trypanosoma cruzi develops in three phases: acute, indeterminate or asymptomatic, and chronic phase (with cardiac or digestive manifestations). Moreover, transmission may occur from infected mothers to newborn, the so-called congenital form. In the present study, humoral responses against T. cruzi total extract and against the 13 amino acid peptide named R-13 derived from the parasite ribosomal P protein, previously described as a possible marker of chronic Chagas heart disease, were determined in chagasic patients and in blood bank donors from endemic areas. While in sera from acute phase, only IgM anti-T.cruzi response was observed, both IgM and IgG anti-T. cruzi antibodies were detected in sera from congenitally infected newborns. The percentage of positive response in sera from blood bank donors was relatively high in endemic regions. Antibodies against the R-13 peptide were present in a large proportion of cardiac chagasic patients but were totally lacking in patients with digestive form of Chagas' disease. Furthermore, anti-R-13 positive responses were detected in congenitally infected newborns.