Resultados posoperatorios y satisfacción en pacientes operados de cirugía ortognática durante los años 2011-2018 en Hospital San José, Chile

Resumen Introducción: Las dismorfosis dentofaciales (DDF) corresponden a un conjunto de alteraciones en la forma, posición o tamaño de los huesos maxilares. La cirugía ortognática es el tratamiento quirúrgico de elección para tratar este tipo de alteraciones, permitiendo la reposición de los maxilares y restitución de las funciones masticatorias, fonéticas y respiratorias, así como la estética facial. Objetivo: Describir resultados posoperatorios y el grado de satisfacción de los pacientes que optaron por la cirugía ortognática durante los años 2011-2018 por el equipo de Cirugía Maxilofacial del Hospital San José. Material y Método: Estudio retrospectivo, se evaluaron los protocolos operatorios de 44 pacientes operados de cirugía ortognática. Criterio de inclusión: pacientes mayores de 15 años con diagnóstico de DDF clases II y III no asociado a síndrome craneofacial. Se aplicó una encuesta a estos pacientes para conocer el grado de satisfacción con respecto a la cirugía ortognática efectuada, presencia de pérdida de sensibilidad neurológica y localización anatómica de ésta si la hubiese. Posteriormente, se relacionaron las variables género, edad del paciente al momento de la cirugía, pérdida de sensibilidad neurológica, tiempo de evolución posoperatorio y clase esqueletal con el nivel de satisfacción del paciente respecto a la cirugía ortognática. Resultados: Un 90,9% de los pacientes está satisfecho con los resultados de la cirugía. No existe una relación estadísticamente significativa entre el grado de satisfacción con la cirugía ortognática y las variables, sexo, edad de operación, pérdida de sensibilidad neurológica (del nervio mentoniano, que da inervación sensitiva al tejido blando del mentón, labio inferior, encía por vestibular de incisivos, canino y primer premolar inferior), tiempo de evolución posterior a la cirugía y clase esqueletal. Conclusión: Existe un alto nivel de satisfacción en los pacientes intervenidos mediante cirugía ortognática. Las cinco variables analizadas no influyen en el nivel de satisfacción de los pacientes posterior a la cirugía ortognática.

Abstract Introduction: Dentofacial deformities are a set of alterations in the shape, position or size of the maxillary bones. Orthognathic surgery is the surgical treatment of choice for this type of alterations, allowing the replacement of the maxillary and restitution of masticatory, phonetic and respiratory functions, as well as facial aesthetics. Aim: Describe post-operative results and level of satisfaction in patients who opted for orthognathic surgery during the years 2011-2018 by the Maxillofacial Surgery team of San José Hospital. Material and Method: Retrospective study, the surgical protocols of 44 patients who underwent orthognathic surgery were evaluated. Inclusion criteria: patients over 15 years old with diagnosis of DDF class II and III not associated with any craniofacial syndrome. A survey was applied to these patients to know the degree of satisfaction with respect to the orthognathic surgery carried out, the presence of loss of neurological sensitivity and its anatomical location, if any. Subsequently, the variables gender, patient age at the time of surgery, loss of neurological sensitivity, time of postoperative evolution and skeletal class were related to the level of satisfaction of patients with orthognathic surgery. Results: 90.9% of patients are satisfied with the results of the surgery. There is no statistically significant relationship between the level of satisfaction patients with orthognathic surgery and the variables, gender, age at the time of surgery, loss of neurological sensitivity (of the mentonian nerve, that gives sensitive innervation to the soft tissue of the chin, lower lip, gum by vestibular of incisors, canine and first lower premolar), time of postoperative evolution and skeletal class. Conclusion: There is a high level of satisfaction in patients undergoing orthognathic surgery. The five variables analyzed do not influence the level of patient satisfaction after orthognathic surgery.

Presencia y biometría de bazo accesorio en individuos chilenos: estudio por tomografía computarizada / Presence and biometry of accessory spleen in Chilean individuals: study by computerized tomography

El bazo se localiza en el cuadrante superior izquierdo del abdomen, relacionándose posteriormente con la 9a a 11a costilla, de las que se separa por el diafragma y el receso costodiafragmático, se localiza por detrás del estómago y lateralmente al riñón izquierdo. Por alteraciones en su desarrollo pueden generarse bazos accesorios (BA), considerándose un tejido ectópico del bazo. Se consideran tejido normal, con los mismos procesos fisiológicos que el bazo principal. Con el propósito de localizar y determinar aspectos biométricos de los mismos, se realizó un estudio de corte transversal y de carácter descriptivo, sobre una muestra de 220 exámenes de TC pertenecientes a pacientes mayores de 18 años del Hospital Regional Hernán Henríquez Aravena, Temuco, Chile. Para este estudio se excluyeron toda aquellas TC con antecedentes de esplenectomía y lesiones de Bazo o peri-esplénicas. El análisis de los datos mostró una prevalencia de 32,3 % de BA, pudiendo ser de una única presencia, dos e incluso tres BA por paciente.De un total de 71 personas que tienen al menos un BA, 34 (47,89 %) fueron de sexo femenino y 37 (52,11 %) de sexo masculino. Hubo 56 pacientes (78,9 %) con un BA, 29 (40,85 %) del sexo femenino y 27 (38,03 %) del masculino; 15 (21,1 %) presentaron más de un BA, 5 (7,04 %) de sexo femenino y 10 (14,08 %) de sexo masculino, si bien se puede observar variación en la cantidad de BA según sexo, no existe una relación estadísticamente significativa entre dichas variables. La ubicación más frecuente encontrada en el plano axial fue la zona antero-medial con 59 casos (66,29 %); asimismo, en el plano sagital, la localización más frecuente fue en el polo inferior con 40 casos (44,44 %). Datos biométricos de estos BA son mostrados en Tablas. Esta información será de gran valor morfológico y médico debido a la escasa literatura existente sobre esta materia en individuos chilenos.

The spleen is located in the upper left quadrant of the abdomen, subsequently related to the 9th to 11th rib, from which it is separated by the diaphragm and the cost-diaphragmatic recess, it is located behind the stomach and laterally to the left kidney. Due to alterations in its development, accessory spleens (AS) can be generated, being considered an ectopic tissue of the spleen. The AS are considered normal tissue, with the same physiological processes as the main spleen. With the purpose of locating and determining biometric aspects of them, a cross-sectional and descriptive study was carried out on a sample of 220 CT scans belonging to patients over 18 years of age at the Hernán Henríquez Aravena Regional Hospital, Temuco, Chile. For this study, all CT scans with a history of splenectomy and spleen or peri-splenic lesions were excluded. The analysis of the data showed a prevalence of 32.3 % of AS, being able to be of a single presence, two and even three AS per patient. Of a total of 71 people who have at least one AS, 34 (47.89 %) were female and 37 (52.11 %) male. There were 56 patients (78.9 %) with a one AS, 29 (40.85 %) of the female sex and 27 (38.03 %) of the male; 15 (21.1 %) presented more than one AS, 5 (7.04 %) female and 10 (14.08 %) male, although variation in the amount of AS according to sex can be observed, no there is a statistically significant relationship between these variables. The most frequent location found in the axial plane was the anteromedial zone with 59 cases (66.29 %); also, in the sagittal plane, the most frequent location was in the lower pole with 40 cases (44.44 %). Biometric data of these AS are shown in tables. This information will be of great morphological and medical value due to the limited existing literature on this subject in Chilean individuals.

Protomedicatos y lazaretos como instituciones de control de la higiene pública en Chile entre 1879 y 1920 / Colleges of royal physicians and isolation hospitals to control public hygiene in Chile from 1879 to 1920

El presente artículo indaga la aparición de dos instituciones de control de la higiene pública en Chile entre los años 1879 y 1920: los protomedicatos y lazaretos. El objeto de estudio utiliza como caso la presencia de la viruela en La Araucanía. Se abordan las características y contexto que adquirió la instalación de estos dispositivos que permitieron al Estado de Chile operacionalizar el asunto de la higiene pública, lo que interpeló a los profesionales de la salud para avanzar a mayores niveles de perfeccionamiento del ejercicio profesional de la medicina. El Estado liberal positivista de fines de siglo XIX comprendió que el tema de la higiene no era solamente una cuestión de responsabilidad individual, sino que tenía una dimensión social, pública y medio ambiental. No sólo había personas que eran higiénicas, sino también ambientes higiénicos y antihigiénicos. Por tanto, se estudia la higiene, el tribunal del protomedicato, la hoja sanitaria, lazaretos, médicos y vacunadores; quienes estuvieron en permanente tensión con las autoridades del gobierno central debido a los insuficientes recursos proporcionados por el Estado para la atención de los enfermos contagiados con viruela. El estudio se orienta desde una metodología cualitativa con un diseño historiográfico con alcances descriptivos densos. Se han utilizado fuentes primarias y secundarias disponibles en archivos en Chile y Alemania. Los resultados evidencian que la presencia de viruela apareció violentamente en el centro sur de Chile en la segunda mitad del siglo XIX y permaneció en la Araucanía hasta la primera mitad del siglo XX. La violencia con que se desarrolló la viruela generó miedo e incertidumbre afectando a personas de diferentes clases sociales, y tuvo como una de sus causas principales las precarias condiciones de salubridad de la población.

This article investigates the emergence of two institutions for the control of public hygiene in Chile between 1879 and 1920: colleges of royal physicians and isolation hospitals using the case of smallpox in La Araucanía, a region located in the South of Chile. We cover the characteristics and context of these institutions that allowed the State of Chile to address the problems of public hygiene and to prompt health professionals to professionalize the practice of medicine. The liberal positivist state of the late nineteenth century understood that the issue of hygiene was not only a matter of individual responsibility but had a social, public, and environmental dimension. People practiced hygiene alongside the existence of hygienic and anti-hygienic environments. Therefore, hygiene, the royal colleges of physicians, health records, isolation hospitals, doctors, and vaccinators are studied. All of these components of the health care system of the time were in permanent tension with the central government authorities due to the insufficient resources provided by the state for the care of infected patients with smallpox. The study follows a qualitative methodology with a descriptive historiographic design. We used archival primary and secondary sources available in Chile and Germany. The results show that the presence of smallpox appeared ferociously in South-Central Chile in the second half of the 19th century and remained in La Araucanía until the first half of the 20th century. The extent to which smallpox spread, spawning fear and insecurity in people of different social classes, had as one of its leading causes the precarious conditions of health and hygiene of the population.

Morphometric parameters of foodborne related-pathogens estimated by transmission electron microscopy and their relation to optical density and colony forming units.

The different morphological characteristics of five bacterial pathogen strains were analyzed through transmission electron microscopy for addressing the particular relationship between optical density and colony-forming units for each strain. Generated linear equations will allow a reliable calculation of bacterial concentrations through simple optical density measurements.

Trends and threshold exceedances analysis of airborne pollen concentrations in Metropolitan Santiago Chile.

Pollen is one of the primary causes of allergic rhinoconjunctivitis in urban centers. In the present study, the concentrations of 39 different pollens in the Santiago de Chile metropolitan area over the period 2009-2013 are characterized. The pollen was monitored daily using Burkard volumetric equipment. The contribution of each type of pollen and the corresponding time trends are evaluated. The concentrations of the pollens are compared with the established threshold levels for the protection of human health. The results show that the total amount of pollen grains originating from trees, grasses, weeds and indeterminate sources throughout the period of the study was 258,496 grains m-3, with an annual average of 51,699 ± 3,906 grains m-3 year-1. The primary source of pollen is Platanus orientalis, which produces 61.8% of the analyzed pollen. Grass pollen is the third primary component of the analyzed pollen, with a contribution of 5.82%. Among the weeds, the presence of Urticacea (3.74%) is remarkable. The pollination pattern of the trees is monophasic, and the grasses have a biphasic pattern. The trends indicate that the total pollen and tree pollen do not present a time trend that is statistically significant throughout the period of the study, whereas the grass pollen and weed pollen concentrations in the environment present a statistically significant decreasing trend. The cause of this decrease is unclear. The pollen load has doubled over the past decade. When the observed concentrations of the pollens were compared with the corresponding threshold levels, the results indicated that over the period of the study, the pollen concentrations were at moderate, high and very high levels for an average of 293 days per year. Systematic counts of the pollen grains are an essential method for diagnosing and treating patients with pollinosis and for developing forestation and urban planning strategies.

Creation of a solid organ transplant program in an underdeveloped country: Mexico's General Hospital transplantation program.

BACKGROUND: With a population of >112 million persons, all Mexicans are entitled to receive medical care by the state and more than half have limited access to healthcare. From January 1985 to March 2009, 40 renal transplants were performed from living donors with a high percentage of complications. In April 2009, a new Solid Organ Transplantation Program was started; herein, we present this enterprise to the international community and briefly present a perspective on the Mexican transplant situation. MATERIALS AND METHODS: We performed a retrospective chart review of kidney and liver transplant recipients from April 2009 to November 2011, including demographic features, immunosuppression, complications as well as initial and 1 month function. RESULTS: We performed 68 kidney (59 living and 9 deceased donors) and 5 liver transplants (cadaveric donors). The kidney transplant recipients were 73.5% males and showed an overall mean age of 29.77 years (range, 18-60). The donor mean age was 34.08 years. Mean recipient creatinine pretransplant was 13.32 mg/dL, while at day 5 it was 2.33 and at month one, 1.32 mg/dL. Five grafts were lost (7.3%): 4 due to death with a functioning graft and 1 due to acute pyelonephritis. Five patients experienced delayed graft function Basiliximab induction was required in all but one who received thymoglobulin owing to a high panel reactive antibody. Maintenance therapy included a calcineurin inhibitor, mycophenolate mofetil (MMF), and prednisone. Liver transplant recipients were 83.6% women. The etiologies were alcoholic cirrhosis (n = 2), primary billiary cirrhosis (n = 1) and hepatitis C virus infection (n = 2). Complications included: reperfusion syndrome (n = 1), convulsive crisis (medication; n = 1), acute respiratory distress syndrome (n = 1), and death (n = 1). Their Model for End-Stage Liver Disease scopes were 10-21. After basiliximab induction, they had maintenance therapy with tacrolimus, MMF, and steroids. The donor mean age was 26.2 years. All survivors show normal liver function tests currently. CONCLUSIONS: From 1985 to 2009, 40 kidney transplants were performed, with multiple complications including donor deaths. Our current results were comparable to international standards, with <15% complication rate.

Novel surgical concept in antireflux surgery: long-term outcomes comparing 3 different laparoscopic approaches.

BACKGROUND: The Nissen fundoplication procedure is the most widely used type of antireflux surgery. The results are not always as good as expected, and several modifications to the original technique have been proposed. Long-term effectiveness studies comparing different techniques of antireflux surgery are limited. Our group developed a new concept in antireflux surgery (complete fixed "nondeformable" fundoplication) in order to improve its outcome; we present the long-term comparative results of this novel concept/technique. METHODS: Overall, 512 patients were included in the study and assigned into 1 of 3 fundoplications groups: partial (131), Nissen (133), and fixed "nondeformable" (121). We compared the groups with each other and with a group who chose to receive medical treatment (MT) (127). All patients underwent clinical evaluation, upper gastrointestinal endoscopy, esophageal manometry, 24-hour esophageal pH monitoring, and the SF-36 health status survey prior to operation and at 1, 5, 10, and 15 years of follow-up. RESULTS: At the 15-year follow-up, we were able to complete the protocol in 319 patients: 103 patients from the partial group, 102 patients from the Nissen group, 97 patients from the fixed "nondeformable" group, and 17 patients from the medical treatment group. A lower prevalence of erosive gastroesophageal reflux disease (GERD) was observed in the fixed "nondeformable" group (7.20%) versus 21.56% for Nissen, 39.80% for partial, and 47.05% for MT (P < .01). Lower esophageal sphincter (LES) pressure and LES length were more constant in the fixed "nondeformable" group (14.7 mm Hg/2.2 cm) compared with the Nissen (9 mm Hg/0.7 cm), partial (7 mm Hg/2 cm), and MT (5.64 mm Hg/1.3 cm) groups (P < .01). Reflux recurrence was observed in 168 patients (13 in fixed "nondeformable," 41 in Nissen, and 98 in partial (P < .01). CONCLUSION: The complete fixed "nondeformable" fundoplication showed best results in studied parameters and had a lower long-term recurrence compared with Nissen and partial techniques.

Effect of dilution rate and nutrients addition on the fermentative capability and synthesis of aromatic compounds of two indigenous strains of Saccharomyces cerevisiae in continuous cultures fed with Agave tequilana juice.

Knowledge of physiological behavior of indigenous tequila yeast used in fermentation process is still limited. Yeasts have significant impact on the productivity fermentation process as well as the sensorial characteristics of the alcoholic beverage. For these reasons a better knowledge of the physiological and metabolic features of these yeasts is required. The effects of dilution rate, nitrogen and phosphorus source addition and micro-aeration on growth, fermentation and synthesis of volatile compounds of two native Saccharomyces cerevisiae strains, cultured in continuous fed with Agave tequilana juice were studied. For S1 and S2 strains, maximal concentrations of biomass, ethanol, consumed sugars, alcohols and esters were obtained at 0.04 h⁻¹. Those concentrations quickly decreased as D increased. For S. cerevisiae S1 cultures (at D=0.08 h⁻¹) supplemented with ammonium phosphate (AP) from 1 to 4 g/L, concentrations of residual sugars decreased from 29.42 to 17.60 g/L and ethanol increased from 29.63 to 40.08 g/L, respectively. The S1 culture supplemented with AP was then micro-aerated from 0 to 0.02 vvm, improving all the kinetics parameters: biomass, ethanol and glycerol concentrations increased from 5.66, 40.08 and 3.11 g/L to 8.04, 45.91 and 4.88 g/L; residual sugars decreased from 17.67 g/L to 4.48 g/L; and rates of productions of biomass and ethanol, and consumption of sugars increased from 0.45, 3.21 and 7.33 g/L·h to 0.64, 3.67 and 8.38 g/L·h, respectively. Concentrations of volatile compounds were also influenced by the micro-aeration rate. Ester and alcohol concentrations were higher, in none aerated and in aerated cultures respectively.

Caracterización y registro del polen atmosférico en la ciudad de Temuco / Characterization and registry of the atmospheric pollen in Temuco, Chile

Se realizó un estudio con el objetivo de cuantificar y caracterizar la carga polínica en la ciudad de Temuco, entre los años 2006-2009. Para el muestreo aerobiológico se utilizó un captador volumétrico Burkard Seven Day Volumetric Spore-Trap®. Las muestras obtenidas fueron analizadas semana tras semanas durante el período en estudio. Con los resultados del conteo polínico semanal se determinaron las 11 principales especies de flora urbana anemófilas de Temuco más susceptibles de producir polinosis. Las mayores concentraciones de polen se obtienen entre septiembre y marzo, siendo las especies más importantes: Pastos (Gramineae/Poaceae), Ciprés (Cupressus sp) y Acedera (Rumex sp).

The aim of this study was to quantify and to characterize the amount ofpollen in the atmosphere of the city of Temuco, Chile from 2006 to 2009. Aerobiological sampling was carried out by using a Seven Day Volumetric Spore-Trap Burkard and the samples were analyzed weekly during the period of study. Results: We determined the 11 principal anemophilus species of urban flora in Temuco responsible for pollinosis. The highest concentration ofpollen were present from september till march, being the most important species the Grasses (Gramineae/Poaceae), Cypress (Cupressus sp), and Sorrell (Rumex sp.).

Effect of atrial septostomy on the survival of patients with severe pulmonary arterial hypertension.

Atrial septostomy (AS) is a palliative treatment for right ventricular failure from severe pulmonary arterial hypertension (PAH). We sought to investigate the effect of AS, alone or combined with PAH-specific pharmacotherapy, on the survival of patients with PAH. We performed a retrospective analysis of the functional and haemodynamic changes in patients with PAH following AS, and long-term survival characteristics for the whole group and separately for the subgroup who received post-procedural pharmacotherapy. 50 procedures performed in 34 patients (mean ± SD age 35 ± 10 yrs) resulted in haemodynamic and symptomatic improvement in most of the patients. Only one (2%) procedure-related death occurred. Due to spontaneous closure of the defect, AS was repeated in 10 patients. In 21 patients, AS was the only form of treatment, while 11 received additional pharmacotherapy after AS. During follow-up (58.5 ± 38 months), 21 patients died; median survival of the group was 60 months (95% CI 43-77 months). Median survival for patients on pharmacotherapy additional to AS was 83 months (95% CI 57-109 months), which was better than that for patients with AS alone (53 months, 95% CI 39-67 months) (log-rank 6.52; p = 0.010). In selected patients with PAH, AS is a safe and effective intervention that exerts a beneficial impact on long-term survival. Survival appears to be improved when AS is combined with PAH-specific pharmacotherapy.

Relación entre posición mandibular y postura cervical en pacientes con retrognatismo / Relation between mandibular position and cervix posture in patients with retrognatism

Se estudió un grupo de 18 pacientes portadores de una dismorfosis dentoesqueletal clase II, con el objeto de determinar un tipo de relación entre retrognatismo y postura cervical. Usamos telerradiografías de perfil tomadas en posición habitual de cabeza, utilizando los análisis cefalométricos de Delaire y Solow. Los resultados obtenidos permitieron concluir que existe una relación directa entre la posición retruída mandibular que presentan los pacientes con dismorfosis dentoesqueletal clase II y la postura cervical, determinando que entre más posterior es la posición mandibular, mayor es la extensión anterior de la columna cervical

Informe anual de las actividades realizadas por las clínicas ambulatorias en el periodo de julio de 1996 a junio de 1997 / Activities of the ambulatory clinics during the period from july 1996 to june 1997

Durante el periodo de julio de 1996 a junio de 1997 las clínicas ambulatorias del programa International Donkey protection Trust (IDPT)- International League For Protection Of Horses (ILPH)-Universidad Nacional Autónoma de México (UNAM), continuaron desarrollando su labor en comunidades rurales de los estados de Puebla, Tlaxcala, Guerrero, Guanajuato, Oaxaca, Hidalgo, Estado de México, Michoacán y Distrito Federal. Se trataron 17 735 animales, entre burros, caballos y mulas, de éstos se atendieron 21 505 condiciones patológicas diferentes. Se continuó trabajando sobre la problemática que prevalece en la plaza ganadera del puente de San Bernabé, Almoloya de Juárez, Estado de México, obteniendo una mejor respuesta por parte de las autoridades del municipio y por comerciantes, pero falta mucho por hacer. Se realizaron dos concursos del "Animal Mejor Cuidado", uno en Ciudad Nezahualcóyotl y otro en el estado de Puebla. Los dos veterinarios responsables de las unidades ambulatorias fueron invitados por los dirigentes de las organizaciónes inglesas a conocer su forma de trabajar y sus instalaciones en Inglaterra. El programa participó en el Congreso Nacional de Médicos Veterinarios Especialistas en Equinos que se llevó a cabo en la ciudad de Guadalajara, Jalisco, y en el Seminario Nacional de Tracción Animal, este último realizado en las instalaciones de la Universidad Autónoma del Estado de México. Los estudiantes continuaron participando con el programa a través del servicio social, especialidad en la modalidad de equinos, prácticas de campo y trabajo voluntario

Assessment and accreditation of Mexican medical schools.

With the objective of evaluating and accrediting the quality of medical education in the country, the Mexican Association of Medical Schools initiated the National Programme for the Strengthening of the Quality of Medical Education (PNFCE). This programme led to the establishment of the National System of Accreditation. Medical school deans in Mexico determined the criteria for the evaluation of quality and its subsequent standards through a consensus process. The following 10 criteria resulted: general basis and educational objectives; government and institutional orientation; educational programme and academic structure; educational process assessment; students; teaching staff; institutional coherence; resources; clinical sites; and administration. Eighty-eight standards were developed in the instrument designed for the self-evaluation phase. The information resulting from the self-evaluation will be verified by a group of experts during a survey visit, which will be finalized with a report to serve as the basis for the decision to be made by the Accreditation Commission. The self-evaluation phase started in 1994. In 1996 four schools submitted their request for accreditation. As of July 1996, one survey visit has been completed and three more are programmed for the second half of the year.

Identificación de especies de enterococcus en muestras clínicas y susceptibilidad a agentes antimicrobianos / Identification of enterococcus species from clinical samples and susceptibility to antimicrobial agents

The genus enterococcus has 12 species of which, E faecalis and E faecium are most important in human infections. A progressive resistance to penicillin and ampicillin has been detected in these species. The aim of this work was to identify Enterococcus species isolated in a hospital and to study their antimicrobial susceptibility. We studied 209 Enterococcus species coming from patients admitted to a public hospital. Their susceptibility to penicillin, ampicillin, imipenem, vancomycin, tetracycline, chloramphenicol, ciprofloxacin, gentamycin and streptomycin was determined with the agar dilution technique. Eighty seven percent of species were E faecalis and 7,1 percent were E fecium, other isolated species were E hirae, E casseliflaws, E avium, E solitarius and E faecalis variant. 38 percent of these species were isolated from the urinary tract, 22 percent from the skin and 14 percent from surgical wounds. All E faecalis species were susceptible to penicillin, ampicillin, imipenem and vancomycin; 27,3 percent were susceptible to tetracycline, 54,7 percent to chloramphenicol and 80 percent to ciprofloxacin. Seventy three percent of E faecium species were susceptible to penicillin, 80 percent to ampicillin and 60 percent to imipenem. 62 percent of E faecalis and 42.4 percent of E faecium were resistant to streptomycin. It is concluded that the correct identification of Enterococcus species has therapeutic implications

Cloning and expression of a Leishmania donovani gene instructed by a peptide isolated from major histocompatibility complex class II molecules of infected macrophages.

The studies reported here describe the isolation of peptides from MHC class II molecules of murine macrophages infected with Leishmania donovani, and the use of the derived peptide sequences to rescue the pathogen peptide donor protein. The isolation of the peptides was carried out by comparing the RP HPLC profile of peptides extracted from infected macrophages with the peptides extracted from noninfected cells. Several distinct HPLC peaks unique to infected macrophages were sequenced. One of the peptides that was not homologous to any known protein was used to instruct the designing of an oligonucleotide sense primer that was used in combination with an oligo dT nucleotide (anti-sense primer) to amplify by PCR a DNA fragment from L. donovani cDNA. The amplified DNA fragment was cloned and used as a probe to screen a L. donovani cDNA library. The cloned gene (Ld peptide gene) has an open reading frame of 525 bp and has no homology with any known protein/gene sequence. Northern blot analyses indicated that the Ld peptide/gene is broadly distributed and expressed among species of the Leishmania genus, in both the amastigote and promastigote life cycle forms. Using the pGEX 2T vector, the gene was expressed and the relationship of the purified recombinant protein with L. donovani was confirmed using both antibody and T cell responses from immunized or infected animals. The gene encodes a 23-kD molecule (Ldp 23) associated with the cell surface of L. donovani promastigotes. In addition, T cells purified from the lymph nodes of BALB/c mice immunized with L. donovani or infected with L. major, and from CBA/J mice infected with L. amazonensis were stimulated to proliferate by the recombinant Ldp 23 and produced high levels of IFN-gamma and no IL 4. This observation suggests that the Ldp 23 is an interesting parasite molecule for the studies concerning the host/parasite interaction because the Th1 pattern of cytokine response that it induces is correlated with resistance to Leishmania infections. These results clearly point to an alternative strategy for the purification of proteins useful for the development of both vaccines and immunological diagnostic tools not only against leishmaniasis but also for other diseases caused by intracellular pathogens.

[Multidisciplinary study of cerebrovascular disorders. II. Cardiovascular profile of occlusive vascular disorders]. / Estudio multidisciplinario de los accidentes vasculares encefálicos. II--Perfil cardiovascular de los accidentes vasculares oclusivos.

Ischemic stroke constitute a mayor cause of morbidity and mortality in the adult population, particularly in the elderly. Heart disease may predispose to ischemic stroke, especially in the presence of transient or permanent precipitating factors such as atrial fibrillation. To elucidate the role of heart disease in predisposing to ischemic stroke we studied the clinical and non invasive cardiac profile (EKG, 2D-Echo, Holter) of 186 consecutive patients, 91 of them embolic (GI) and 96 non embolic (lacunar, atherothrombotic, others) (GII), as determined by brain CT scan and thorough clinical evaluation. Age and male/female ratio were significantly different (71 + 13 vs 65 + 12 years, 40/60 vs 65/35, p < 0.003). Hypertension was equally common in both groups (38 and 40%). Patients in GI had higher prevalence of valvular heart disease (23 vs 1%), atrial fibrillation (67 vs 10%), 2D Echo left atrial enlargement (45 vs 16%) and supraventricular ectopy in Holter (59 vs 32%) p < 0,001. By contrast absence of heart disease (45 vs 19%), ST-T changes in EKG (28 vs 14%), left ventricular hypertrophy in 2D Echo (28 vs 9%) and ventricular ectopy in Holter (54 vs 23%) were more prevalent in GII patients, p < 0.001. Multiple stepwise logistic regression analysis showed age > 70 years (relative risk (RR) 1.67), valvular heart disease (RR 2.25), chronic AF (RR 2.44) and paroxysmal AF (RR 1.89) were significant independent predictors of embolic stroke, whereas the presence of left ventricular hypertrophy in 2D-Echo (RR 0.76) and frequent ventricular premature beats in Holter (RR 0.47) were predictors of occlusive non embolic stroke. Thus, the clinical and non invasive cardiac profile of embolic and non embolic ischemic stroke is significantly different, which is relevant to preventive strategies.

[Anticardiolipin antibodies and primary antiphospholipid syndrome of the central nervous system: report of 10 clinical cases]. / Anticuerpos anticardiolipinas y síndrome antifosfolípidos primario del sistema nervioso central: comunicación de 10 casos clínicos.

An association between anti-phospholipid antibodies and different disorders of the central nervous system has been described recently. We used an ELISA technique and detected anti-cardiolipin antibodies of the IgG or IgM variety in a series of 10 patients: 4 had occlusive stroke, 2 brain hemorrhage, 2 chorea, 1 a Sneddon syndrome and 1 vascular cephalea. The diagnosis of primary anti-phospholipid syndrome was suggested after ruling out systemic lupus in all patients.

Quantitative evaluation of intracellular degradation in Entamoeba invadens.

A quantitative study on digestion of erythrocytes by Entamoeba invadens was attempted. Trophozoites of the IP-1 strain were fed red blood cells for 30 min, and subsequently phagocytosis was stopped by means of osmotic shock; post-phagocytosis incubations for up to 15 h were made in order to evaluate intracellular digestion, after staining the red blood cells with benzidine. Eighty-two per cent of trophozoites were capable of phagocytosing erythrocytes, containing an average of 5.5 erythrocytes per amoeba. Erythrocyte digestion within amoebae was shown by loss of benzidine-stainable material and proceeded with a first-order kinetics, with a t1/2 approximately 7 h. Within 15 h there were no amoebae containing erythrocytes. The procedure described may be useful for the evaluation of intracellular digestion in other Entamoeba species.