Manifestación de una interacción farmacológica entre rivastigmina y tolterodina en un paciente geriátrico con diagnósticos de Parkinson y vejiga hiperactiva: reporte de caso / Management of the drug interaction between rivastigmine and tolterodine in one elderly patient with Parkinsonand overactive bladder

El uso conjunto de medicamentos anticolinérgicos e inhibidores de la colinesterasa no es recomendado por los fabricantes de los productos, ya que pueden afectar la función cognitiva de los pacientes, esto se ve acentuado en la población geriátrica polimedicada. Uno de los problemas relacionados a la medicación, en los que los farmacéuticos realizan con frecuencia intervenciones, es el número de interacciones farmacológicas potenciales que pueden expresarse con los distintos medicamentos que emplean los pacientes. Presentamos el caso de un paciente con diagnóstico de Parkinson y vejiga neurogénica que presentó pérdida de la concentración y memoria asociada a una interacción farmacológica entre un inhibidor directo de la colinesterasa (rivastigmina) y un anticolinérgico (tolterodina). El mecanismo descrito para la interacción es la disminución del efecto esperado de rivastigmina por efecto de inhibición de la tolterodina en los receptores colinérgicos, impidiendo la liberación de acetilcolina y quitando así el blanco terapéutico de la enzima que se inhibe por efecto de la tolterodina. La intervención oportuna y el manejo adecuado de las interacciones farmacológicas durante la atención sanitaria es de suma importancia para evitar daños en los pacientes, incluido la exacerbación de enfermedades que se encuentran controladas, debido a la adición de otros medicamentos a la farmacoterapia

The use of anticholinergic and cholinesterase inhibitors set is not recommended by drug laboratory producers, because the use of the drugs can affect the cognitive function of the patients, this is more common in the elderly and polymedicated population. For the pharmacist is a challenge to have control of the number of potential drug interactions that can express with the different drugs that the patient has in a prescription. We present a case of an expression of drug-drug interaction between anticholinergic (tolterodine) and direct cholinesterase inhibitor (rivastigmine) in a patient with Parkinson disease and overactive bladder, the outcome of this interaction is the decrease the effect of rivastigmine by inhibition of cholinergic receptors, keep the inhibition of release acetylcholine and remove the target of the enzyme that rivastigmine inhibit, the expression of the interaction in the patient is expressed in loss of concentration and memory, the management and report of this interaction is very important for the patient with control of the disease

Morfometría nuclear de hepatocitos esteatósicos y esteatósicos estimulados con laser infrarrojo / Nuclear morphometric of the steatotic hepatocytes and stimulated steatotisc with infrared laser

Un total de 24 ratas hembras de 4 meses de vida con peso aproximado de 250 g recibieron una solución de alcohol 40 % disuelto en agua lo cual derivó en una esteatosis alcohólica multivesicular. A 12 de estas ratas esteatósicas se le aplicó estimulaciones de láser infrarrojo con dosis de 8 J/cm2 durante 15 días consecutivos. Posteriormente las ratas fueron sacrificadas y se extrajeron muestras tanto de hígado esteatósico como del estimulado para enseguida ser procesadas para microscopía electrónica de transmisión. De hepatocitos esteatósicos y esteatósicos estimulados se obtuvieron microfotografías electrónicas de transmisión con aumentos finales de 9.500 X, las cuales fueron sometidas a estudios morfométricos para determinar tanto el número de poros nucleares como de fracciones volumétricas de los siguientes componentes celulares: Areas celular y nuclear, fracciones volumétricas de núcleos y nucléolos, eu y heterocromatina. De igual manera se determinó la relación nucleo-citoplasmática de ambos tipos celulares. Del análisis de los resultados entre hepatocitos alcohólicos y alcohólicos estimulados se visualiza que existen notables diferencias en todos los componentes celulares cuantificados. Se concluye que los efectos de la estimulación con lásr infrarrojo provoca en los hepatocitos una drástica transformación en su ultraestructura y en su morfología, situación que se traduciría, por ende, en una variación funcional, representando de esta manera el efecto que dicha estimulación provoca en los hepatocitos.

A total of 24 female rats, aged 4 months and weighing approximately 250 g and they given a solution of 40 % alcohol dissolved in water, leading to alcoholic multivesicular steatosis and 12 of rats was given and infrared laser with dose of 8 J/cm2 during 15 d. The rats were then killed and samples of steatosis and stimulated and were taken and processed for examination by transmission electron microscope. Transmission electron microscope microphotographs steatotic hepatocytes and stimulated steatotic were obtained with final magnification of 9,500 X. They were subjected to morphometric studies to determine the number of nuclear pores and volumetric fractions and areas the following components: cellular and nuclear area, volumetric fractions of nucleus, nucleolus, eu and heterochromatin, nucleocytoplamic ratio of each cell type was determined. Analysis of the results between alcoholic hepatocytes and stimulate alcoholic shows that noticeable differences exist in all the cell components quantified. It is concluded that the effects of the stimuli of laser infrared provoke in the hepatocytes, a drastic transformation of their ultrastructure and morphology. This finally leads to functional variations, representing the effects produced by this stimulate in the hepatocytes.

Poros Nucleares y Función Celular en Epitelio Mamario / Nuclear Pores and Cellular Function

El presente artículo tiene como objetivo central evidenciar la interesante relación que se establece entre la función celular y el número de poros nucleares, relación que modula el activo intercambio nucleo-citoplasmatico en distintas etapas del ciclo celular de la estirpe HC11.

The main objective of this article is related to the study of different existing relationships between cellular function and the number of nuclear pores in order to explain the amount of nuclear-cytoplasmatic exchange through HC11 cell cycle stages.

Expression of myostatin in the spotted rose snapper Lutjanus guttatus during larval and juvenile development under cultured conditions.

In this study, the developmental expression pattern of myostatin (mstn) in the spotted rose snapper Lutjanus guttatus under culture conditions is presented. The full coding sequence of mstn from L. guttatus was isolated from muscle tissue, obtaining 1134 nucleotides which encode a peptide of 377 amino acids. The phylogenetic analysis indicated that this sequence corresponds to mstn-1. mstn expression was detected in embryonic stages, and maintained at low levels until 28 days post-hatch, when it showed a significant increase, coinciding with the onset of metamorphosis. After that, expression was fluctuating, coinciding probably with periods of rapid and slow muscle growth or individual growth rates. mstn expression was also analysed by body mass with higher levels detected in smaller animals, irrespective of age. mstn was also expressed in other tissues from L. guttatus, presenting higher levels in brain, eye and gill. In brain for instance, two variants of mstn were isolated, both coding sequences were identical to muscle, except that one of them contained a 75 nucleotide deletion in exon 1, maintaining the reading frame but deleting two conserved cysteine residues. Phylogenetic analysis indicated that this brain variant was also mstn-1. The function of this variant is not clear and needs further investigation. These results indicate that mstn-1 participates in different physiological processes other than muscle growth in fishes.

Microscopía electrónica de nucleos hepáticos estimulados con dosis crecientes de laser infrarrojo / Electron microscopy hepatic nuclei stimulated with increasing doses of infrared laser

Un total de 20 ratas hembras de 4 meses de vida con peso aproximado de 250 gramos fueron divididas en 4 grupos de animales rotulados como A, B, C y D. El grupo A corresponde al control y los demás grupos recibieron respectivamente estimulaciones con laser infrarrojo con dosis crecientes de 4, 8 y 16 Joules por cm2 durante 15 días consecutivos en 5 puntos del hígado. Posteriormente las ratas fueron sacrificadas y se extrajeron muestras tanto de hígado control como de los estimulados con inducciones infrarrojas para enseguida ser procesadas para microscopía electrónica de transmisión. De los hepatocitos se obtuvieron microfotografías electrónicas de transmisión con aumentos finales de 9.500 X, las cuales fueron sometidas a estudios morfométricos para determinar fracciones volumétricas de sus núcleos y estructuras nucleares. De igual manera se cuantificaron las áreas nucleares, celulares y se determinó la relación núcleo-citoplasmática de los tipos celulares estudiados. Analizados los resultados entre los hepatocitos controles e irradiados se visualiza que existen notables diferencias en la totalidad de los parámetros cuantificados concluyéndose que los efectos de las estimulaciónes infrarrojas con dosis crecientes genera transformaciones en su ultraestructura y en su morfología, fundamentalmente en el aumento de los volúmenes nucleares, y celulares, los volúmenes de cromatina y de la relación-núcleo-citoplasmática situación que se traduciría en una variación funcional, representando de esta manera un efecto evidente que estas inducciones infrarrojas generan.

Twenty-four four-month-old female rats weighing approximately 250 grams were divided into four groups labeled A, B, C and D. A corresponds to the normal group and the other groups received stimulation increasing doses with 4, 8 and 16 J/cm2 of infrared laser respectively for 15 consecutive days in five points of the liver. The rats were then sacrificed and samples of normal liver and liver stimulated with infrared inductions were extracted for immediate processing via transmission electron microscopy. From cell types transmission electron microphotographs were obtained at magnifications of 9500 X these were subjected to morphometric studies to determine volumetric fractions of the nuclei and nuclear structures. Likewise, cell and nuclear areas and nuclear-citoplasmatic relation were quantified. Analysis of the results between normal and radiated hepatocytes revealed notable differences in all the cell components quantified. It is concluded that the effects of increasing infrared stimulation doses brings transformation in their ultrastructure and morphology, fundamentally in the considerable increase in nuclear volume, chromatin volume and the nuclear-citoplasmatic relation, which ultimately translates into a functional variation, thus representing an obvious impact produced by these infrared inductions.

El retículo endoplasmático liso en hepatocitos estimulados con distintas dosis de láser infrarrojo / The smooth endoplasmic reticulum in hepatocytes stimulated with different doses of infrared laser

Veinticuatro ratas hembras Sprague Dawley de 4 meses de vida con peso aproximado de 250 g, fueron divididas en cuatro grupos (A, B, C y D), donde el grupo A (control) no recibió estimulación infrarroja, B se irradió con láser infrarrojo 4 J/cm², C con dosis de 8 J/cm² y D con 16 J/cm². La estimulación infrarroja se realizó diariamente, por 15 días ininterrumpidos. Las ratas fueron sacrificadas y se extrajeron muestras tanto de hígado normal (control) como estimulado con las distintas dosis infrarrojas, las que fueron procesadas para microscopía electrónica de transmisión. De los hepatocitos normales y estimulados, se obtuvieron microfotografías con aumentos finales de hasta 36.500 X, que fueron sometidas a estudios morfométricos para determinar fracciones volumétricas con especial énfasis en el retículo endoplásmico liso (REL) y de los siguientes componentes celulares: retículo endoplasmático rugoso (RER), mitocondrias, glicógeno, eu y heterocromatina. De igual manera se cuantificaron las áreas celulares y nucleares. Del análisis de los resultados entre hepatocitos normales y estimulados con diferentes dosis infrarrojas, se visualiza que existen notables diferencias en todos los componentes celulares cuantificados particularmente el REL. Se concluye que las estimulaciones infrarrojas provocan una drástica transformación en la ultraestructura y morfología de los hepatocitos, lo que provocaría una variación funcional, representando de esta manera el efecto que estas estimulaciones provocan en este tipo celular.

A total of 24 female Sprague-Dawley rats aged 4 months and weighing approximately 250 g, were divided into four groups labeled A, B, C and D. Group A received no infrared stimulation and served as control. Group B was radiated with a dose of 4 J/cm² of infrared laser, Group C with doses of 8 J/cm² and Group D with 16 J/cm². This infrared stimulation was carried out daily for 15 days uninterrupted. The rats were then sacrificed and samples of both normal-control liver and liver stimulated with the different infrared doses were extracted for immediate processing via transmission electron microscopy. Transmission electron microphotographs were obtained at magnifications of 21300X from both normal and stimulated hepatocytes; these were subjected to morphometric studies to determine volumetric fractions with special emphasis on the smooth endoplasmic reticulum (SER) and the following cell components: rough endoplasmic reticulum (RER), mitochondria, glycogen, eu and heterochromatin. Likewise, cell and nuclear areas were quantified. Analysis of the results of normal and stimulated hepatocytes with different infrared doses showed considerable differences in all the quantified cell components and particularly from the SER it is concluded that the effects of these stimulations bring about a drastic transformation in the ultrastructure and morphology of the hepatocytes, which may ultimately translate into a functional variation, thus representing the effect that these stimulations cause in this cell type.

Análisis morfométrico de hepatoesteatosis microvesicular alcohólica de ratas / Morphometric analysis of alcoholic microvesicular hepatic steatosis in rats

Un total de 24 ratas hembras de 4 meses de vida con peso aproximado de 250 gramos fueron divididas en dos grupos de animales rotulados como A y B. El grupo A se mantuvo con pellet y agua ad libitum sirviendo como controles mientras que el grupo B conservaba el pellet y recibía una solución de alcohol 40% disuelto en agua lo cual derivó en una esteatosis alcohólica multivesicular. Ambos grupos se mantuvieron en estas condiciones por 60 días. Posteriormente las ratas fueron sacrificadas y se extrajeron muestras tanto de hígado normal-control como de hígado graso para enseguida ser procesadas para microscopía electrónica de transmisión. De hepatocitos normales y esteatósicos se obtuvieron microfotografías electrónicas de transmisión con aumentos finales de 9.500X, las cuales fueron sometidas a estudios morfométricos para determinar fracciones volumétricas de los siguientes componentes celulares: Retículo endoplasmático rugoso, mitocondrias, inclusiones lipídicas y de glicógeno, eu y heterocromatina. De igual manera se cuantificaron las áreas celulares y nucleares. Del análisis de los resultados entre hepatocitos normales y alcohólicos se visualiza que existen notables diferencias en todos los componentes celulares cuantificados. Se concluye que los efectos de la ingesta diaria de alcohol provoca en los hepatocitos una esteatosis microvesicular que genera una drástica transformación en su ultraestructura y en su morfología, situación que se traduciría, por ende, en una variación funcional, representando de esta manera el efecto que esta droga provoca en los hepatocitos.

A total of 24 female rats, aged 4 months and weighing approximately 250 g, were divided into two groups, called A and B. The group A animals were kept on pellets and water ad libitum and served as controls, while group B animals were fed pellets and given a solution of 40% alcohol dissolved in water, leading to alcoholic multivesicular steatosis. Both groups were kept under these conditions for 60 days. The rats were then euthanized and samples of normal-control and fatty liver were taken and processed for examination by transmission electron microscope. Transmission electron microscope microphotographs of normal and steatotic hepatocytes were obtained with final magnification of 9,500 X. They were subjected to morphometric studies to determine the volumetric fractions of the following cell components: Rough Endoplasmic Reticulum, mitochondria, lipid and glycogen inclusions, and eu- and heterochromatin. In addition, the cell and nucleus areas were quantified and the nucleo cytoplasmic ratio of each cell type was determined. Analysis of the results between normal and alcoholic hepatocytes shows that noticeable differences exist in all the cell components quantified. It is concluded that the effects of the daily consumption of alcohol provoke microvesicular steatosis in the hepatocytes, generating a drastic transformation of their ultrastructure and morphology. This finally leads to functional variations, representing the effects produced by this drug in the hepatocytes.

Analisis comparativo del número de neurofilamentos en nervios isquiáticos de rata sometidos a neuropraxia tratadas con láser de baja intensidad y ultrasonido terapéutico / Comparative analysis of the number of neurofilaments in rat sciatic nerve undergoing neuropraxia treated by low-level laser and therapeutic ultrasound

Es habitual que tras una compresión nerviosa se aplique terapia, ya sea, a través de laser de baja intensidad (LBI) o ultrasonido (US). El objetivo de este trabajo fue determinar la efectividad de dichos tratamientos para reparar el citoesqueleto neuronal evaluando la variación en el número de neurofilamentos. Se realizó un diseño experimental, en el cual se utilizaron 30 ratas que fueron separadas en 6 grupos: 1- control sano; 2- control lesionado; 3- irradiado con LBI 2J/cm2; 4- irradiado con LBI 10 J/cm2; 5- irradiado con US 0,5W/cm2 y 6- irradiado con US 1W/cm2. Con excepción del grupo 1 los especímenes fueron anestesiados y se les realizó la compresión del nervio isquiático derecho utilizando una presión de 40N durante 45 segundos. Veinticuatro horas después de la compresión se inició la irradiación con LBI y US, según protocolo. En nuestra investigación constatamos que el incremento en el número de neurofilamentos se relacionó con la dosis aplicada de LBI y US. El valor medio de neurofilamentos/0,25 mm2 obtenidos en cada grupo fue: 1 - 128; 2 - 100; 3 - 156; 4 - 140; 5 - 100; 6 - 148. La aplicación de LBI de y de US terapéutico aumenta el número de neurofilamentos en nervios isquiáticos de rata sometidos a neuropraxia, siendo el LBI más eficaz en comparación al US. Se agrega que estas terapias para inducir la regeneración del nervio lesionado se relacionan al tipo de protocolo utilizado, lo que demuestra la necesidad de establecer la adecuada dosis de irradiación con el propósito de obtener la mejor respuesta terapéutica.

Therapy by low-level laser (LLL) or ultrasound (US) are commonly used as treatment after nerve crush. The aim of this study was to determine the effectiveness of such treatments to repair the neuronal cytoskeleton evaluating the variation in the number of neurofilaments. For this an experimental design was performed, which involved 30 rats divided into 6 groups: 1 - control healthy; 2 - control injured; 3 - irradiated by LLL 2 J/cm2; 4 - irradiated by LLL 10 J/cm2; 5 - irradiated by US 0.5 W/cm2 and 6 - irradiated by US 1W/cm2. With the exception of group 1 all specimens were anesthetized and underwent right sciatic nerve compression using 40N pressure for 45 seconds. Twenty-four hours after compression irradiation was started by LLL and US according protocol. In our research we found that the increase in the number of neurofilaments was related to the applied dose of LLL and US. The average value of neurofilaments / 0.25 mm2 obtained in each group was: 1 - 128; 2-100; 3-156; 4-140; 5-100; 6-148. We concluded that the application of LLL and therapeutic US increases the number of neurofilaments in rat sciatic nerve undergoing neuropraxia, with LLL being more effective compared to the US. Furthermore we concluded that the effectiveness of therapies to induce regeneration of injured nerve is related to the type of protocol used, demonstrating the need to establish an adequate radiation dose with the purpose of obtaining the best therapeutic response, thus achieving successful treatment.

Análisis morfométrico ultraestructural de células normales de glándula parótida de rata / Ultrastructural morphometric analysis from normal parotid gland cells of rat

A partir de 10 ratas hembras con un peso aproximado de 250 g y 4 meses de vida, fueron obtenidas quirúrgicamente muestras de glándula parótida las que se trataron con técnicas de microscopía electrónica de transmisión para posteriormente obtener microfotografías de células parotideas con aumentos finales de hasta 21300 X. En las citadas microfotografías se aplicaron técnicas morfométricas con el objetivo de cuantificar las fracciones volumétricas que los distintos componentes ocupan en estas células normales, describiendo de esta manera sus volúmenes y relacionándolos con la funcionalidad que desempeñan en esta célula normal. Se evaluaron las fracciones volumétricas pertenecientes a: citoplasma, núcleo, mitocondrias, retículo endoplasmático rugoso (RER), gránulos de zimógeno, eu y heterocromatina. De igual forma, se cuantificó las áreas celulares y nucleares. Contando con los datos numéricos producto de la evaluación morfométrica de sus componentes se podrá determinar el patrón de distribución de sus organelos y de funcionalidad de esta célula activa en la síntesis y secreción de proteínas representada por los gránulos de zimógeno de diastasa y diversas proteínas salivales.

From 10 female rats weighing approximately 250 g and aged 4 months, samples of parotid gland were obtained surgically which were treated with transmission electronic microscopy in order to obtain microphotographs with final increases of up to 21,300 X. Morphometric techniques were applied to these microphotographs to quantify the volumetric fractions that the different components occupy in these normal cells, thus describing their volumes and relating them to their functionality in this normal cell. Volumetric fractions were evaluated pertaining to: cytoplasm, nucleus, mitochondria, rough endoplasmic reticulum (RER), zymogen granules, eu and heterochromatin. Likewise, cell and nuclear areas were quantified. With the numerical data from the morphometric evaluation of its components, it was possible to determine the distribution pattern of the organelles and functionality of this cell active in protein synthesis and secretion represented by diastase zymogen granules and various salivary proteins.

Morbilidad materna grave e ingreso a cuidado intensivo: Hospital Clínico Universidad de Chile (2006-2010) / Intensive care admissions due to severe maternal morbidity

Background: Maternal morbidity is a quality of care indicator. The frequency of severe maternal morbidity that requires an intensive care management has increased, due to an increase in maternal age. Aim: To describe the severe and acute maternal morbidity spectrum that requires an intensive care management in a University Hospital. Material and Methods: Review of medical records of 89 pregnant women with a mean age of 29 years, admitted to an Intensive Care Unit (UCI) between 2006 and 2010. Results: Mean gestational age on admission was 32 weeks. The main comorbidities identified were chronic hypertension (13.5%), hypothyroidism (4.5%) and coagulopathies (6.7%). Severe preeclampsia, sepsis and obstetric hemorrhage were the main causes of admission. Length of stay ranged from 1 to 28 days. Seventy eight percent of patients were admitted in the immediate postnatal period. Mechanical ventilation was required in 24% of patients for a median of three days. The longer unit lengths of stay were observed in patients with preeclampsia and non-obstetric severe sepsis (pyelonephritis and pneumonia). Seven abortions and seven perinatal deaths were recorded. The latter were mainly secondary to severe preeclampsia/ HELLP syndrome. Neonatal morbidity was related to prematurity (19% hyaline membrane, 18% persistent ductus and 4% cerebral hemorrhage). There were no maternal deaths. Conclusions: Preeclampsia and its complications were the main causes of maternal ICU admission. In this series, there were no maternal deaths and the perinatal survival rate was 92%.

[Ministry of Health Intensive Care Medicine Commission: proposals for the development of the discipline]. / Medicina intensiva en Chile: desafíos para su desarrollo. Documento de la Comisión Nacional de Medicina Intensiva del Ministerio de Salud.

Intensive care medicine in Chile is still in its dawn. It has experienced a progressive growth in the last decade, but continues to be weak. Although investments in the discipline have increased fivefold, there is still a severe deficiency of intensive care specialists. This issue will represent a serious problem in the near future. The Ministry of Health gathered an expert committee to study the problem and propose solutions for the future development of the discipline.

Efecto de estimulaciones infrarrojas sobre hepatoesteatosis microvesicular alcohólica de ratas / Infrared laser effect on alcoholic rat hepatic microvesicular steatosis

24 ratas hembras de 4 meses de vida con peso aproximado de 250 gramos fueron divididas en dos grupos de animales, A y B. Ambos grupos se mantuvieron con pellet y solución de alcohol 40% durante 60 días generándoseles una hepatoesteatosis microvesicular. Los hígados de los animales pertenecientes al grupo B fueron estimulados con láser infrarrojo 6 J/cm2 durante 15 días consecutivos. Posteriormente, las ratas fueron sacrificadas y se extrajeron muestras de hígado y luego procesadas para microscopía electrónica de transmisión. De ambos tipos celulares se obtuvieron microfotografías electrónicas de transmisión con aumentos finales de 8.500 X, las cuales fueron sometidas a estudios morfométricos para determinar fracciones volumétricas de los siguientes componentes celulares: Retículo endoplasmático rugoso (RER), mitocondrias, inclusiones lipídicas y de glicógeno, eu y heterocromatina. De igual manera se cuantificaron las áreas celulares y nucleares. Del análisis de los resultados entre hepatocitos esteatósicos e irradiados se visualiza que existen diferencias en todos los componentes celulares cuantificados y se concluye que los efectos de la estimulación infrarroja con dosis de 6 J/cm2 provoca en los hepatocitos con esteatosis microvesicular transformación en su ultraestructura y en su morfología, fundamentalmente en la disminución acentuada de las infiltraciones lipídicas hasta en un 80% situación que se traduciría, en una variación funcional, representando de esta manera un efecto evidente que estas inducciones infrarrojas generan.

24 four-month-old female rats weighing approximately 250 grams were divided into two groups labeled A and B. Both groups were fed pellets and a 40% alcohol solution for 60 days, which caused a microvesicular hepatic steatosis. The livers of the animals in Group B were stimulated with 6 J/cm2 of infrared laser for 15 consecutive days. The rats were then sacrificed and samples of both steatosic liver and liver stimulated with infrared inductions were extracted for immediate processing via transmission electron microscopy.From both cell types transmission electron microphotographs were obtained at magnifications of 9500 X; these were subjected to morphometric studies to determine volumetric fractions of the following cell components: rough endoplasmic reticulum (RER), mitochondria, lipid and glycogen inclusions, euchromatin and heterochromatin. Likewise, cell and nuclear areas were quantified. Analysis of the results between steatosic and radiated hepatocytes revealed notable differences in all the cell components quantified. It is concluded that the effects of infrared stimulation with a dose of 6 J/cm2 brings about in the steatosic hepatocytes a microvesicular transformation in their ultrastructure and morphology, fundamentally in the considerable decrease in lipid infiltrations to 80%, which ultimately translates into a functional variation, thus representing an obvious impact produced by these infrared inductions.

Medicina intensiva en Chile: desafíos para su desarrollo. Documento de la Comisión Nacional de Medicina Intensiva del Ministerio de Salud / Ministry of Health Intensive Care Medicine Commission: Proposals for the development of the discipline

Intensive care medicine in Chile is still in its dawn. It has experienced a progressive growth in the last decade, but continues to be weak. Although investments in the discipline have increased fivefold, there is still a severe deficiency of intensive care specialists. This issue will represent a serious problem in the near future. The Ministry of Health gathered an expert committee to study the problem and propose solutions for the future development of the discipline.

Prone Position Ventilation Used during a Transfer as a Bridge to Ecmo Therapy in Hantavirus-Induced Severe Cardiopulmonary Syndrome.

Background. Transport of critically ill patients is a complex issue. We present a case using prone positioning as a bridge to extracorporeal membrane oxygenation (ECMO), performed by a critical retrieval team from a university hospital. Case Report. A 28-year-old male developed fever, progressive respiratory failure, and shock. He was admitted to ICU from a public hospital, and mechanical ventilation was begun, but clinical response was not adequate. ECMO was deemed necessary due to severe respiratory failure and severe shock. A critical retrieval team of our center was assembled to attempt transfer. Prone positioning was employed to stabilize and transfer the patient, after risk-benefit assessment. Once in our hospital, ECMO was useful to resolve shock and pulmonary edema secondary to Hantavirus cardiopulmonary syndrome. Finally, he was discharged with normal functioning. Conclusion. This case exemplifies the relevance of a retrieval team and bridge therapy. Prone positioning improves oxygenation and is safe to perform as transport if performed by a trained team as in this case. Preparation and organization is necessary to improve outcomes, using teams and organized networks. Catastrophic respiratory failure and shock should not be contraindications to transferring patients, but it must be done with an experienced team.

[Intensive care admissions due to severe maternal morbidity]. / Morbilidad materna grave e ingreso a cuidado intensivo: Hospital Clínico Universidad de Chile (2006-2010).

BACKGROUND: Maternal morbidity is a quality of care indicator. The frequency of severe maternal morbidity that requires an intensive care management has increased, due to an increase in maternal age. AIM: To describe the severe and acute maternal morbidity spectrum that requires an intensive care management in a University Hospital. MATERIAL AND METHODS: Review of medical records of 89 pregnant women with a mean age of 29 years, admitted to an Intensive Care Unit (UCI) between 2006 and 2010. RESULTS: Mean gestational age on admission was 32 weeks. The main comorbidities identified were chronic hypertension (13.5%), hypothyroidism (4.5%) and coagulopathies (6.7%). Severe preeclampsia, sepsis and obstetric hemorrhage were the main causes of admission. Length of stay ranged from 1 to 28 days. Seventy eight percent of patients were admitted in the immediate postnatal period. Mechanical ventilation was required in 24% of patients for a median of three days. The longer unit lengths of stay were observed in patients with preeclampsia and non-obstetric severe sepsis (pyelonephritis and pneumonia). Seven abortions and seven perinatal deaths were recorded. The latter were mainly secondary to severe preeclampsia/ HELLP syndrome. Neonatal morbidity was related to prematurity (19% hyaline membrane, 18% persistent ductus and 4% cerebral hemorrhage). There were no maternal deaths. CONCLUSIONS: Preeclampsia and its complications were the main causes of maternal ICU admission. In this series, there were no maternal deaths and the perinatal survival rate was 92%.