Interest of proviral HIV-1 DNA genotypic resistance testing in virologically suppressed patients candidate for maintenance therapy.

Switch of antiretroviral therapy in virologically suppressed HIV-infected patients is frequent, to prevent toxicities, for simplification or convenience reasons. Pretherapeutic genotypic resistance testing on RNA can be lacking in some patients, which could enhance the risk of virologic failure, if resistance-associated mutations of the new regimen are not taken into account. Proviral DNA resistance testing in 69 virologically suppressed patients on antiretroviral treatment with no history of virological failure were pair-wised compared with pre-ART plasma RNA resistance testing. The median time between plasma (RNA testing) and whole blood (proviral DNA testing) was 47 months (IQR 29-63). A stop codon was evidenced in 23% (16/69) of proviral DNA sequences; these strains were considered as defective, non-replicative, and not taken into consideration. Within the non defective strains, concordance rate between plasma RNA and non-defective proviral DNA was high both on protease (194/220 concordant resistance-associated mutations=88%) and reverse transcriptase (28/37 concordant resistance-associated mutations=76%) genes. This study supports that proviral DNA testing might be an informative tool before switching antiretrovirals in virologically suppressed patients with no history of virological failure, but the interpretation should be restricted to non-defective viruses.

Trasplante de órganos, una mirada desde el judaísmo en el siglo XXI / The point of view of Judaism on organ donation

Background: Organ transplantation frequently constitutes a source of public concern. Dealing with such a complex medical problems requires a process of recognition of the different attitudes that social groups have toward organ transplantation attitudes which might vary accordingly to cultural and religious diversity. Judaism is the focus of this review. Our objective is to contribute to the knowledge that Chilean health professionals have about the Jewish point of view on organ transplantation. The supreme value of life is a premise of Judaism, so saving a life should precede the enforcement of certain Old Testament's prohibitions. However, it is difficult and misleading to attempt to define a unique point of view-even though there is an overwhelming majority who are in favor of organ donation-because different theological interpretations and recommendations are continuously in debate. We conclude that the mainstream Jewish position is not significantly different from the contemporary Western thought, even though a minority in Judaism is opposed to cadaveric organ donation.

[The point of view of Judaism on organ donation]. / Trasplante de órganos, una mirada desde el judaísmo en el siglo XXI.

BACKGROUND: Organ transplantation frequently constitutes a source of public concern. Dealing with such a complex medical problems requires a process of recognition of the different attitudes that social groups have toward organ transplantation attitudes which might vary accordingly to cultural and religious diversity. Judaism is the focus of this review. Our objective is to contribute to the knowledge that Chilean health professionals have about the Jewish point of view on organ transplantation. The supreme value of life is a premise of Judaism, so saving a life should precede the enforcement of certain Old Testament's prohibitions. However, it is difficult and misleading to attempt to define a unique point of view--even though there is an overwhelming majority who are in favor of organ donation--because different theological interpretations and recommendations are continuously in debate. We conclude that the mainstream Jewish position is not significantly different from the contemporary Western thought, even though a minority in Judaism is opposed to cadaveric organ donation.

Dermal absorption of chlorpyrifos in human volunteers.

OBJECTIVE: The methods and results are described of a study on the dermal absorption of chlorpyrifos (CPF) in humans established via urinary excretion of the metabolite 3,5,6-trichloro-2-pyridinol (TCP). METHODS: Two dermal, single, doses of CPF were applied in two study groups (A and B) each comprising three apparently healthy male volunteers who gave their written informed consent. The clinical part of the study was conducted in compliance with the ICH Guideline and the EC principles of good clinical practice (GCP). An approximately 0.5 ml dilution of CPF in ethanol was applied to an area of approximately 100 cm(2) of the volar aspect of the forearm, resulting in doses of either 5 mg (A) or 15 mg (B) of CPF per study subject. Duration of dermal exposure was 4 h, after which the non-absorbed fraction was washed off. The following samples were collected at pre-determined intervals for the determination of either CPF or its metabolite TCP: dosing solutions, wash-off fractions and urine samples collected up to 120 h after dosing. RESULTS: A relatively large fraction of CPF (42%-67% of the applied dose) was washed off from the exposed skin area. Application of either 5 mg (A) or 15 mg CPF (B) resulted in the total urinary excretion of 131.8 microg (A) or 115.6 microg (B) of TCP 120 h after dosing. This indicated that 4.3% of the applied dose has been absorbed (A), while in group (B) no significant increase in urinary TCP (115.6 microg) was established. The latter indicates that an increase in the dermal dose at a fixed area does not increase absorption, which suggests that the percutaneous penetration rate was constant. Further, it was observed that the clearance of CPF by the body was not completed within 120 h, suggesting that CPF or TCP was retained by the skin and/or accumulated in the body. A mean elimination half-life of 41 h was established. CONCLUSION: The results show that daily occupational exposure to CPF may result in accumulation of CPF and/or its metabolites, possibly resulting in adverse effects.

Differential susceptibility of rats and guinea pigs to the ototoxic effects of ethyl benzene.

The present study was designed to compare the ototoxic effects of volatile ethyl benzene in guinea pigs and rats. Rats showed deteriorated auditory thresholds in the mid-frequency range, based on electrocochleography, after 550-ppm ethyl benzene (8 h/day, 5 days). Outer hair cell (OHC) loss was found in the corresponding cochlear regions. In contrast, guinea pigs showed no threshold shifts and no OHC loss after exposure to much higher ethyl benzene levels (2500 ppm, 6 h/day, 5 days). Subsequently, a limited study (four rats and four guinea pigs) was performed in an attempt to understand these differences in susceptibility. Ethyl benzene concentration in blood was determined in both species after exposure to 500-ppm ethyl benzene (8 h/day, 3 days). At the end of the first day, blood of the rats contained 23.2+/-0.8-microg/ml ethyl benzene, whereas the concentration in guinea pig blood was 2.8+/-0.1 microg/ml. After 3 days, the concentration in both species decreased with respect to the first day, but the ethyl benzene concentration in rat blood was still 4.3 times higher than that in guinea pig blood. Thus, the difference in susceptibility between the species may be related to the ethyl benzene concentration in blood.

[Adenocarcinoma in Barrett's esophagus. A retrospective study of 46 patients followed during 3.5 years]. / Adenocarcinoma en esófago de Barrett. Estudio retrospectivo de 46 pacientes seguidos durante 3,5 años.

OBJECTIVE: To determine the incidence of adenocarcinoma in patients with Barrett's esophagus and to study the characteristics in these patients. METHODS: Between January 1988 and June 1997 was diagnosed 46 patients with Barrett's esophagus. In all tem was analyzed the age, the follow-up period, the chief presenting symptoms leading to endoscopy, endoscopy esophagitis and complications of Barrett's esophagus. RESULTS: The mean age at the time of Barrett's diagnosis was 58 years. The mean follow-up period was 43 months. Presenting symptoms were heartburn in 35 (76%) patients, dysphagia in 3 (6.5%), thoracic pain 3 (6.5%), hemorrhage 2 (4.5%) and others in 3 (6.5%). Endoscopic esophagitis was present in 24 (52%) patients during the follow-up. Complications developed was stricture, ulceration or haemorrhage in 14 (30.4%) patients, two (4.3%) have adenocarcinoma and one dysplasia. Incidence of adenocarcinoma was 1/82 patient-years of follow-up. All three patients with adenocarcinoma or dysplasia was males. Two of the three presented with heartburn and the mean follow-up until development of dysplasia or cancer was 63 months. CONCLUSIONS: Heartburn and endoscopic esophagitis is frequent in these patients. The risk of development of and adenocarcinoma or others complications is high.

Adenocarcinoma en esófago de Barrett: estudio retrospectivo de 46 pacientes seguidos durante 3.5 años / Adenocarcinoma in Barrett's esophagus: a retrospective study of 46 patients followed 3.5 years

Introducción: El reflujo gastroesofágico es uno de los mecanismos fisiopatológicos más importantes para el desarrollo de esófago de Barrett (EB). Los pacientes con EB presentan un riesgo elevado de desarrollar adenocarcinoma de esófago. Objetivo: 1º Estudiar las características clínicas de los pacientes con esófago de Barrett (EB) en el área de Baracaldo-Sestao. 2º Analizar el riesgo de desarrollar adenocarcinoma sobre esófago de Barrett en nuestros pacientes. Métodos: Se han analizado retrospectivamente los EB diagnosticados entre 12.000 endoscopias altas realizadas en nuestro Hospital desde 1988 a Junio de 1997. En total se han diagnosticado 46 pacientes con EB. En ellos, se ha analizado: edad y clínica al diagnóstico, presencia de esofagitis endoscópica, tiempo de seguimiento, complicaciones y desarrollo de adenocarcinoma. Resultados: La edad media fue de 58 años. 33 (72%) eran hombres y 13 (28 %) mujeres. El tiempo medio de seguimiento fue de 43 meses. La clínica de presentación fue pirosis en 35 (76%), disfagia en 3 (6,5%), dolor torácico en 3 (6,5%), hemorragia digestiva en 2 (4,5%) e inespecífica en otros 3 (6,5%) pacientes. En 24 (52%) casos hubo en algún momento de la evolución esofagitis endoscópica. Durante el seguimiento, 33 (72%) no presentaron complicaciones, 10 (22%) presentaron úlcera, estenosis o hemorragia, 2 (4,5%) degeneraron a adecarcinoma y 1 (2,25%) presentó displasia. La incidencia media fue de 0,56/46 casos/año. Los 2 pacientes que degeneraron presentaron un seguimiento mayor (87 meses frente a 41 meses del resto), todos eran hombres, la clínica fue pirosis en 1 y en otra inespecífica y la edad media de ellos fue de 63 años. Conclusiones: 1º La pirosis y la presencia de esofagitis endoscópica está presente en la mayoría de los pacientes con EB. 2º La presencia de complicaciones, así como la degeneración maligna, es relativamente frecuente en nuestro grupo de pacientes (AU)

Visual field defects in vascular lesions of the lateral geniculate body.

Corresponding retinal nerve fibres begin their path in the eyes and end in a single visual cortical cell. Because of this arrangement, lesions in the anterior visual pathway produce incongruent visual field defects and in the posterior pathway congruent field defects. The lateral geniculate body is on the anterior third of the visual pathway. A lesion of this nucleus produces moderately to completely congruent visual field defects. Five patients with ischaemic lesions of the lateral geniculate body are reported. Two patients had a wedge-shaped homonymous hemianopia, two other cases had congruent superior homonymous quadratic defects and the fifth a quadruple sector defect. The lateral geniculate body has a dual blood supply from the anterior choroidal artery (branch from internal carotid artery) and from the lateral choroidal artery (branch from the posterior cerebral artery). A schematic diagram has been devised which shows that a knowledge of the visual field disrupted can identify the arterial system involved.

Muertes infantiles extrahospitalarias en un servicio de salud metropolitano / Clinical and epidemiological findings in infants which were dead on arrival to hospital

Con el propósito de describir algunas características clínicas y sociales de los niños menores de un año que llegan al hospital después de fallecer, se revisaron los antecedentes de 262 de estos casos, registrados en el Hospital "Sótero del Río" en el quinquenio 1985 a 1989, los que representaban 24% de la mortalidad infantil del sector, según ocurrencia. Destacaron, entre otros hallazgos, mayor frecuencia del sexo masculino en menores de seis meses (61,2%), antecedentes de bajo peso al nacer (25,1%) y hospitalización previa (41,7%) y mayor incidencia en los meses fríos (77,1% entre abril y septiembre). Otros factores menos relevantes fueron bajos ingresos familiares (58% menos de 50 dólares mensuales), juventud materna (30% menor de 20 años) e inestabilidad de la pareja (43%). Se constató temperatura sobre 40-C en 20% de los niños en que ésta fue controlada. Sólo en cuatro casos hubo insuficiencia de recursos asistenciales para su atención previa. Las medidas preventivas tendientes a disminuir la mortalidad infantil extrahospitalaria deberían, probablemente, incluir educación a las madres en la clínica de niño sano sobre grupos, síntomas y signos de riesgo, consulta oportuna, manejo de emergencia del síndrome febril y de la asfixia. Por parte de la organización de salud, se requieren además medidas que faciliten al máximo una atención accesible y expedita a todos los pacientes

[Auditory evoked potentials in Fisher's syndrome. A clinical case]. / Potenciales evocados auditivos en el síndrome de Fisher. Caso clínico.

A 15 year old patient developed ataxia 2 weeks after an upper respiratory infection. Absent reflexes, external ophthalmoplegia, bilateral ptosis, isochoric mydriasis and week photomotor reflexes (Bell's phenomenon) were noted. A slight increase in protein but not cell content of the CSF was observed. Miller-Fisher syndrome was diagnosed on clinical grounds and visual and auditory evoked potentials were explored and found to be normal. This is in complete agreement to the literature and indicates indemnity of the central nervous system in Miller-Fisher's syndrome. Peripheral nervous system abnormalities that have been identified by pathologic and radiologic studies may explain all of the alterations observed in this syndrome.

[Hemobilia with spontaneous resolution. Sonographic diagnosis and follow-up]. / Hemobilia con resolución espontánea. Diagnóstico y evolución con ecografía.

We describe a case of hemobilia after liver biopsy, which resolved spontaneously. Clinical, analytical and sonographic monitoring were performed until the patient returned to normal. We highlight the particular characteristics of the onset and evolution in our case, as well as the role played by ultrasonography in diagnosing and monitoring. We conclude by pointing out the increasing frequency of hemobilia as a complication to invasive techniques.

Diabetic complete external ophthalmoplegia.

A 69-year-old diabetic patient taking oral hypoglycemic drugs and with no systemic complications presented a right peripheral facial palsy, and 2 months later a complete right external ophthalmoplegia with sparing of the pupillary function. Clinical, radiologic, and other laboratory investigation ruled out compressive, infectious, and inflammatory etiology. Four months later, after achieving good metabolic control, there was almost complete recovery of the ophthalmoplegia without signs of aberrant regeneration of the third nerve. Diabetes is proposed as the etiology of this case. A possible anatomic substrate is presented to explain the findings.

Evolución oftalmológica de pacientes con transplante renal / Ophtalmologic evolution of patients with renal transplantation

Se estudia la evolución oftalmológica de 41 pacientes insuficientes renales crónicos tratados con transplante renal con 1 a 8 años de observación. 2 casos (5%) con retinopatía hipertensiva severa e importante compromiso de la agudeza visual mejoran significativamente después del post-operatorio. 34% de los pacientes presentan algún grado de opasidad del cristalino (catarata). Sólo el 5% requirió cirugía de la catarata. La hipertensión ocular (glaucoma) se observó en el 5% de los casos