Dose escalation by brachytherapy for gynecological cancers.

Brachytherapy (BT), a type of focal cancer radiation therapy, delivers a highly focused dose of radiation to localized tumors, sparing surrounding normal tissue. Brachytherapy has been used to treat gynecologic malignancies, particularly cervical cancer, for over 100 years. From the first gynecologic brachytherapy treatments in the early 20th century to the modern era, significant transformations have taken place, largely due to advances in technology. The development of high-dose-rate sources, remote afterloaders, new applicators, and three-dimensional image guidance has increased tumor dose and, consequently, local control and survival, reinforcing brachytherapy's role as an integral component of gynecologic cancer treatment. Current research efforts involving biomarker research, integration of new imaging modalities, radiosensitizing therapies are aimed at further personalizing the dose delivered in BT to further improve local control and reduce treatment's related toxicities.

Integration of functional imaging in brachytherapy.

Functional imaging allows the evaluation of numerous biological properties that could be considered at all steps of the therapeutic management of patients treated with brachytherapy. Indeed, it enables better initial staging of the disease, and some parameters may also be used as predictive biomarkers for treatment response, allowing better selection of patients eligible for brachytherapy. It may also improve the definition of target volumes with the aim of dose escalations by dose-painting. Finally, it could be useful during the follow-up to assess response to treatment. In this review, we report how functional imaging is integrated at the present time during the brachytherapy procedure, and what are its potential future contributions in the main tumour locations where brachytherapy is recommended. Functional imaging has great potential in the contact of brachytherapy, but still, several issues remain to be resolved before integrating it into clinical practice, especially as a biomarker or in dose painting strategies.

Versatility of Prolyl Oligopeptidase B in Peptide Macrocyclization.

Cyclic peptides are promising compounds for new chemical biological tools and therapeutics due to their structural diversity, resistance to proteases, and membrane permeability. Amatoxins, the toxic principles of poisonous mushrooms, are biosynthesized on ribosomes as 35mer precursor peptides, which are ultimately converted to hydroxylated bicyclic octapeptides. The initial cyclization steps, catalyzed by a dedicated prolyl oligopeptidase (POPB), involves removal of the 10-amino acid leader sequence from the precursor peptide and transpeptidation to produce a monocyclic octapeptide intermediate. The utility of POPB as a general catalyst for peptide cyclization was systematically characterized using a range of precursor peptide substrates produced either in E. coli or chemically. Substrates produced in E. coli were expressed either individually or in mixtures produced by codon mutagenesis. A total of 127 novel peptide substrates were tested, of which POPB could cyclize 100. Peptides of 7-16 residues were cyclized at least partially. Synthetic 25mer precursor peptide substrates containing modified amino acids including d-Ala, ß-Ala, N-methyl-Ala, and 4-hydroxy-Pro were also successfully cyclized. Although a phalloidin heptapeptide with all L amino acids was not cyclized, partial cyclization was seen when l-Thr at position #5 was replaced with the naturally occurring D amino acid. POPB should have broad applicability as a general catalyst for macrocyclization of peptides containing 7 to at least 16 amino acids, with an optimum of 8-9 residues.

Programa de transición: una intervención para adolescentes con diabetes tipo 1: estudio de casos y controles / Transition program: an intervention for adolescents with type 1 diabetes: cases and controls study

Introduction: The transition programs (TP) are planned interventions with specific aims which support type 1 diabetes adolescents in their process to emigrate from a pediatric care system to an adult care system. Objective: To evaluate the effectiveness of a TP in type 1 diabetes adolescents. Subjects and Method: This study was performed in 20 adolescents: 10 in TP and 10 controls (no TP) attended in an adult care system in a traditional way. The applied program included: coordination of attention dates, administrative supervision of the cases, and integral health team attention: physician every three months, psychologist with psychosocial follow-up every three months, nutricionist and university nurse according to the case necessities. After a year of the TP implementation the indicators of adherence were evaluated: continuity of care, regular medical appointments, physician/adolescent relationship, psychosocial follow-up, and to maintain or improve the HbA1c. The statistical analysis of variables comparison was performed with Kwallis Test o Mann-Whitney Test, in STATA 12.0 program. Results: At comparing groups, it was found that the intervened adolescents presented a major frequency of: continuity of diabetes care, regular medical appointments, physician/adolescent relationship and psychosocial follow-up (p < 0,01); the indicator of maintaining or improving the HbA1c was better in the patients with TP (60 percent vs 30 percent) yet not significant. Conclusion: In type 1 diabetes adolescents, with the applied TP we get better indicators of adherence to the diabetes treatment

La alta prevalencia de lesiones premalignas gástricas y el bajo rendimiento diagnóstico de la visión endoscópica son argumentos a favor de la toma sistemática de biopsias gástricas por Protocolo Sydney / The high prevalence of gastric premalignant lesions and the low diagnostic performance of endoscopic vision advocate towards a systematic gastric biopsy sampling using Sydney Protocol

Background: Atrophic gastritis (AG) and intestinal metaplasia (IM) are stages that appear in the process of gastric carcinogenesis. Their presence requires programmed endoscopic vigilance. Objectives: To determine the frequency of AG and IM in gastric biopsies (GB) taken according to Sydney Protocol and to correlate them with endoscopic findings. Methods: Retrospective descriptive analysis of 233 upper gastrointestinal endoscopies with GB per Sydney Protocol. OLGA (Operative Link for Gastritis Assessment) and OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment) scores were calculated based on the GB description. Endoscopic findings were analyzed for atypical findings and compared to the GB report. Statistic analysis for Kappa and ANOVA was performed via Stata 12. Results: Mean age of patients was 58 ± 12 years. 69% were women. The frequency of AG and IM was 44% and 33% in the antrum, 31% and 20% in the angular incisure and 14% and 9% in the body, respectively. AG and IM were more frequent in the antrum (p < 0.05). AG and IM were more severe in the angular incisure and body (p < 0.05). We were unable to calculate OLGA and OLGIM in 6% and 9% of cases, respectively, due to absence of severity description in GB. 53% were OLGA 0, 42% OLGA I-II and 5% OLGA III-IV. 70% were OLGIM 0, 25% OLGIM I-II and 5% OLGIM III-IV. Agreement between endoscopic and histological findings was best for IM in the antrum (75.5%, Kappa 0.4). Sensitivity and specificity of endoscopic findings were 39% and 70% for AG, and 30% and 85% for IM, respectively. Conclusion: AG and IM are frequent findings in our patients. Due to the low endoscopic sensitivity for AG and IM, we suggest a systematic GB sampling using Sydney Protocol in patients over 40 years old.

Introducción: La gastritis crónica atrófica (GCA) y la metaplasia intestinal (MI) son etapas en el proceso de carcinogénesis gástrica, su presencia requiere control endoscópico programado. Objetivos: Determinar la frecuencia de GCA y MI en biopsias gástricas (BG) por protocolo de Sydney y relacionarlas con el hallazgo endoscópico. Métodos: Estudio descriptivo mediante revisión de 233 endoscopias digestivas altas con BG por Protocolo Sydney. Se graduó puntaje OLGA (Operative Link for Gastritis Assessment) y OLGIM (Operative Link for Gastric Intestinal Metaplasia Assessment) según la descripción de la BG. Se definió el hallazgo endoscópico según su informe y se comparó con BG como patrón de referencia. Estadística: Stata 12 para Kappa y ANOVA. Resultados: Edad promedio 58 ± 12 años, 69% mujeres. La frecuencia de GCA y MI en antro fue de 44 y 33%, en ángulo 31 y 20% y en cuerpo 14 y 9%, respectivamente. Hubo mayor frecuencia de GCA y MI en antro (p < 0,05). La graduación de GCA y MI fue mayor en ángulo y cuerpo (p < 0,05). No se obtuvo OLGA en 6% y OLGIM en 9% por ausencia de graduación. La frecuencia de OLGA 0 fue de 53%, OLGA I-II 42%, OLGA III-IV 5%, OLGIM O 70%, OLGIM I-II 25% y OLGIM III-IV 5%. La mejor correlación se observó entre la MI antral endoscópica con la histológica (75,5%, Kappa 0,4). La sensibilidad y especificidad endoscópica fue de 39 y 70% para GCA y 30 y 85% para MI. Conclusión: GCA y MI son hallazgos frecuentes en nuestros pacientes. Por la baja sensibilidad endoscópica en la identificación de GCA y MI sugerimos la toma sistemática de BG por protocolo de Sydney en pacientes mayores de 40 años.

Experiencia con insulina degludec en pacientes diabéticos Tipo 1 del Hospital San Juan de Dios Santiago / Experience with degludec insulin in Type 1 diabetic patients at the San Juan de Dios Hospital

OBJECTIVE: To study the efficacy and safety of degludec insulin in Type 1 diabetic patients. PATIENTS AND METHOD: In a prospective study, 230 type 1 diabetics patients, average aged 34 years age and 14 years of diagnosis of diabetes and treated with two doses of insulin glargine U-100, were changed to degludec. Patients had glycosylated hemoglobins (HbA1c) greater than 10 percent. Results were recorded at 3 and 6 months with parameters clinical, biochemical, insulin requirements per kilogram of weight (U/kg/wt) and hypoglycemia. Capillary glycemia was evaluated three times a day and the dose of insulin degludec every two weeks. The statistical analysis used was average and rank, standard deviation, normal Swilk test, categorical Chi2 and continuous ANOVA or Kwallis, and p < 0.05. A psychological survey was conducted to evaluate satisfaction with the new treatment. RESULTS: Fasting blood glucose decreased from 253 (range 243-270) at 180 mg/dl (172-240) at 3 months and at 156 (137-180) at 6 months after the change insulin (p < 0.05). HbA1c, initially 10.6 percent (10.4-12.2) decreased to 8.7 percent (9.3-10.1) and 8.3 percent (8.7-9.7) at 3 and 6 months, respectively (p < 0.05). There was a decrease in basal insulin requirements from 0.7 to 0.4 U/kg/60 percent reduction in hypoglycaemia; both mild and moderate and severe. Isolated nocturnal hypoglycaemias were recorded in only 4 patients in this group. CONCLUSION: Six months of treatment with degludec insulin reduces fasting blood glucose, glycosylated hemoglobin and hypoglycemia, both mild and moderate severe and nocturnal, which makes this new ultra-long acting basal insulin a safe and effective tool for the management of type 1 diabetics patients

New Ambiguity in Probing CP Violation in Neutrino Oscillations.

If neutrinos get mass via the seesaw mechanism the mixing matrix describing neutrino oscillations can be effectively nonunitary. We show that in this case the neutrino appearance probabilities involve a new CP phase ϕ associated with nonunitarity. This leads to an ambiguity in extracting the "standard" three-neutrino phase δ_{CP}, which can survive even after neutrino and antineutrino channels are combined. Its existence should be taken into account in the planning of any oscillation experiment aiming at a robust measurement of δ_{CP}.

[Benefits of breathing-adapted radiation therapy for breast cancer]. / Bénéfices de la radiothérapie avec asservissement respiratoire dans le traitement du cancer du sein.

PURPOSE: The purpose of this study was to compare free-breathing radiotherapy, end-expiration gating and end-inspiration gating for left breast cancer, with respect to the target volume coverage and dose to organs at risk. PATIENTS AND METHODS: Sixteen patients underwent 3D and 4D simulation CT. For each patient, five dosimetric plans were compared: free breathing, end-inspiration gating, end-expiration gating, and two optimised plans with a 3mm reduction of the posterior field edge to create optimised end-inspiration and end-expiration plans. Dose-volume parameters, including planning target volume coverage and dose to lung, heart and left anterior descending coronary artery were analysed. RESULTS: Planning target volume coverage was adequate and similar in the five dosimetric plans (P=0.49). Significant advantage was found for end-inspiration gating in sparing the ipsilateral lung, heart and left anterior descending coronary artery compared to free-breathing 3D radiotherapy. Optimised end-inspiration was even more favourable than end-inspiration gating (P<0.05), with less dose delivered to the ipsilateral lung, heart and left anterior descending coronary artery. When compared to end-expiration gating, end-inspiration gating dosimetric outcomes were similar regarding lung and left anterior descending coronary artery doses, but the heart dose was inferior on the end-inspiration gating compared to end-expiration gating. CONCLUSION: Breathing-adapted radiation therapy allowed for dose reduction to organs at risk (left lung, heart and left anterior descending coronary artery), while keeping the same planning target volume coverage. Therefore it can be considered as an interesting option for left breast cancer radiation treatment.

Cervix cancer brachytherapy: high dose rate.

Cervical cancer, although less common in industrialized countries, is the fourth most common cancer affecting women worldwide and the fourth leading cause of cancer death. In developing countries, these cancers are often discovered at a later stage in the form of locally advanced tumour with a poor prognosis. Depending on the stage of the disease, treatment is mainly based on a chemoradiotherapy followed by uterovaginal brachytherapy ending by a potential remaining tumour surgery or in principle for some teams. The role of irradiation is crucial to ensure a better local control. It has been shown that the more the delivered dose is important, the better the local results are. In order to preserve the maximum of organs at risk and to allow this dose escalation, brachytherapy (intracavitary and/or interstitial) has been progressively introduced. Its evolution and its progressive improvement have led to the development of high dose rate brachytherapy, the advantages of which are especially based on the possibility of outpatient treatment while maintaining the effectiveness of other brachytherapy forms (i.e., low dose rate or pulsed dose rate). Numerous innovations have also been completed in the field of imaging, leading to a progress in treatment planning systems by switching from two-dimensional form to a three-dimensional one. Image-guided brachytherapy allows more precise target volume delineation as well as an optimized dosimetry permitting a better coverage of target volumes.

Caries e índice de higiene oral en niños con diabetes mellitus tipo 1 / Dental caries and hygiene oral index in children with diabetes mellitus type 1

Introducción: La diabetes mellitus tipo 1 (DM1) influye en la salud oral. Una alta glicemia podría asociarse a una disminución del flujo salival, acumulo de placa bacteriana y formación de caries. Nuestro objetivo fue determinar la prevalencia de caries e índice de higiene oral (IHO) en niños con DM1 de la Región del Maule-Chile del año 2008. Pacientes y Método: Se diseñó un estudio de corte transversal. Se examinó población menor de 15 años con DM1 del Hospital Regional de Talca. Se registró historia de caries (dientes cariados/obturados/ perdidos) según índice COPD-ceod; IHO (> 1,2 alto acumulo de placa) y potencial cariogénico de dieta (alto/ medio/bajo). Se analizó la relación estadística entre historia de caries con sexo, IHO y dieta. Resultados: 25 niños con DM1 fueron analizados. La prevalencia de caries fue 92 por ciento siendo mayormente en hombres (p = 0,03) y asociada a una mala higiene (p < 0,01). El promedio COPD-ceod fue 2,96 +/- 2,33 y 2 +/- 2,64 respectivamente. El IHO promedio fue 1,8 +/- 2,64 siendo 84 por ciento tipo mala. 21 niños (84 por ciento) tuvieron un potencial cariogénico de dieta bajo, no asociándose a la presencia de caries (p = 0,17). Conclusión: La salud oral de los niños DM1 fue precaria pudiendo corresponder directamente a la mala higiene oral y no con la dieta consumida.

Introduction: Type 1 Diabetes mellitus (DM1) undeniably affects oral health. High glucose levels may be associated with low salivary flow, accumulation of plaque and tooth decay. The objective of this study is to determine the prevalence of caries and Oral Hygiene Index (OHI) in children with DM1 in Maule Region, Chile during 2008. Patients and Method: A cross-sectional study was designed to examine patients under 15 years old with DM1, who were admitted to Talca Regional Hospital. History of caries (decayed, sealed and lost teeth) was registered according to the COPD-dmft index, OHI (> 1.2 high accumulation of plaque) and potential of cariogenic diet (high, medium or low). The statistical relationship between caries history and gender, OHI and diet was analyzed. Results: 25 children cases with DM1 were studied; the prevalence of caries was 92 percent, which was mostly in boys (p = 0.03) and associated with poor hygiene (p < 0.01). The average COPD- ceod index was 2.96 +/- 2.33 and 2 +/- 2.64 respectively. The average OHI was 1.8 +/- 2.64, 84 percent corresponded to bad oral hygiene. 21 children (84 percent had a diet with low cariogenic potential, not associated to the presence of caries (p = 0.17). Conclusion: The children oral health was precarious and it may be associated directly with poor oral hygiene and not with the food consumed.

Asociación entre tuberculosis y diabetes mellitus en la región metropolitana / Associated tuberculosis and diabetes mellitus in Santiago de Chile metropolitan area

Introducción: Los pacientes con diabetes mellitus (DM) son reconocidos como grupo de riesgo para desarrollar tuberculosis. Sin embargo, existe un importante sub-registro de la diabetes como factor de riesgo entre los casos de tuberculosis, que no permite cuantificar la magnitud de este grupo. Este estudio busca determinar laprevalencia de DM entre los casos de tuberculosis (TB) diagnosticados el año 2012 en la Región Metropolitana y estimar la asociación entre estas dos patologías. Método: Se efectuó un estudio transversal analítico, en que todos los casos de TB mayores de 15 años de la Región Metropolitana del año 2012 consignados en el Registro Nacional de Tuberculosis, fueron buscados en el Sistema de Información para la Gestión de Garantías en Salud (SIGGES) para determinar si tenían o no DM. Se realizó el análisis de prevalencias por edad, sexo y Servicio de Salud y se determinó el nivel de asociación con la razón de prevalencia y la estimación de la tasa de incidencia de tuberculosis entre diabéticos y no diabéticos. Resultados: Del total de casos de TB de la región Metropolitana se excluyeron 23 casos por no disponer de la información necesaria, quedando un total de 821 casos. La prevalencia de DM fue de 15,6 por ciento (13,2-18,2), con una razón de prevalencia ajustada por edad de 1,29 (1,28-1,29) respecto a la población general y de 1,73 (1,72-1,73) ajustada por sexo. La tasa de incidencia estimada de TB entre población diabética es de 24,3 por 100.000, 1,7 veces la de la población general de la región. Conclusiones: La prevalencia de DM en la población con tuberculosis de la Región Metropolitana fue mayor que la encontrada en la población general y se ratifica a los diabéticos como grupo de riesgo para desarrollar tuberculosis.

Background: Diabetes mellitus (DM) is recognized as an important risk factor to tuberculosis (TB). However, there is significant diabetes under registration among tuberculosis cases which does not allow quantify the magnitude of this group. This study aims to determine the prevalence of DM among TB cases diagnosed in 2012 in Santiago de Chile, metropolitan area and to estimate the association of these two diseases. Method: A cross sectional study was undertaken. TB cases reported in the National Register of Tuberculosis were sought in the Information System for Management of Health Guarantees (SIGGES) to determine we ther or not they had be sides DM. The analysis of prevalence by age, sex and health service area was carried out, prevalence ratio was used to determine the level of association, and incidence rate of tuberculosis among diabetics and non-diabetics was estimated. Results: 23 TB cases were excluded for lack of necessary information, leaving a total of 821 cases. Prevalence of DM was 15.6% (13.2-18.2), with a prevalence ratio adjusted by age of 1.29 (1.28-1.29) respect to general population, and 1.73 (1.72-1.73) adjusted by sex. The estimated incidence rate of TB among diabetic population is 24.3 per 100,000, that is to say 1.7 times higher than general population of the region. Conclusions: Prevalence of DM in tuberculosis cases in Metropolitan Region was greater than in the general population. The study confirms that diabetics are a risk group for developing tuberculosis.

Eficacia del Folrex(R) en la rehabilitación motora de los miembros superiores, en pacientes con infarto cerebral agudo / Efficacy of Folrex(R) in motor rehabilitation of the upper limbs in patients with acute cerebrovascular infarction

Introducción. La enfermedad cerebrovascular es la tercera causa de muerte y la causa más frecuente de discapacidad del adulto. El déficit motor es la secuela más frecuente superando el 50%. La rehabilitación motora se ve limitada por procesos inflamatorios locales, por lo tanto el uso de cremas con acción antiinflamatoria asociado a la fisioterapia habitual pudiera ser útil en estos pacientes. Material y métodos. Se realizó un ensayo clínico controlado con placebo en dos grupos paralelos para demostrar la eficacia del Folrex(R) en la rehabilitación motora de los miembros superiores en los pacientes con enfermedad cerebrovascular isquémica aguda. Los criterios de inclusión, edad entre 18 y 90 años de menos de 24 horas de evolución y con una puntuación superior de 4 en NIHSS, apoyo familiar y consentimiento a participar en esta investigación. El tamaño muestral necesario fue de 20 pacientes para cada grupo. El criterio principal de evaluación fue la escala de Fugl-Meyer, con evaluaciones al inicio, al quinto día y al mes. Resultados. Hubo una mejoría significativa (p<0,04) del estado motor según la escala de Fugl-Meyer en el grupo de estudio en comparación con el control. Conclusiones. Folrex(R) en crema es eficaz en la rehabilitación motora de los miembros superiores de los pacientes con enfermedad cerebrovascular isquémica aguda (AU)

Introduction. Cerebrovascular disease is the third most common cause of death and the most common cause of disability in the adult. Motor deficit is one of the most significant sequels, this being found in over 50% of the patients. Motor rehabilitation is limited by local inflammatory conditions, so that topical application of anti-inflammatory creams, associated to the usual physiotherapy, may be useful in these patients. Material and methods. A placebo-controlled trial performed was performed in two parallel groups to demonstrate the efficacy of Folrex(R) in motor rehabilitation of the upper limbs in patients with acute ischemic cerebrovascular disease. Inclusion criteria were age from 18 to 90 years, less than 24hours of evolution, score on NIHSS superior to 4, adequate family support, with explicit consent to participate in this study obtained from patients and their families. The necessary sample size was 20 patients per group. The main evaluation criteria was the Fugl-Meyer scale, with evaluations at the onset, on the first day and at one month. Results. There was significant improvement in motor function (P<0.04) on the Fugl-Meyer scale, compared to the control group. Conclusions. Folrex(R) cream is effective in motor rehabilitation of the upper limbs in patients with acute ischemic cerebrovascular disease (AU)

[Management of malignant phyllodes tumors of the breast: the experience of the Institut Curie]. / Prise en charge des tumeurs phyllodes malignes du sein: l'expérience de l'institut Curie.

PURPOSE: Given the scarcity of malignant phyllode tumours of the breast and the absence of consensus regarding their management justify the need for institutional retrospective evaluations of clinical practices. PATIENTS AND METHODS: Retrospective study with central pathology review of the 25 consecutive patients treated at the Institut Curie (Paris, France) between 1969 and 2006 for non metastatic malignant phyllodes tumors of the breast. The median follow-up was 65 months (7-257 months). RESULTS: Median age at diagnosis was 52 years (20-64 years). Breast surgery was conservative in five patients (20%). Surgical margins were wide (> 10mm), narrow, involved or unknown in respectively 17 (68%), three (12%), three (12%) and two (8%) patients. Median tumour size was 65 mm (12-250 mm). Adjuvant radiotherapy was delivered in seven (28%) patients (two patients, post-tumorectomy; five patients, post-mastectomy) and 13 patients (52%) received anthracycline-based adjuvant chemotherapy. Five-year overall survival rate was 91% (95% CI, 80-100%). Five patients (20%) developed distant metastases (one after chemotherapy) and three (12%) locoregional relapse (one after tumorectomy and unknown margin without radiotherapy, two after mastectomy and involved margins with radiotherapy). CONCLUSION: Wide breast surgery (that can be conservative in selected patients) is the mainstay of the treatment of non metastatic malignant phyllodes tumors of the breast. To better determine the respective roles of adjuvant systemic treatment and radiotherapy, further clinical studies and the search for new prognostic and predictive factors remain necessary.

Emergence in Brazil of methicillin-resistant Staphylococcus aureus isolates carrying SCCmecIV that are related genetically to the USA800 clone.

An increasing incidence of nosocomial infections caused by non-multiresistant methicillin-resistant Staphylococcus aureus (nMMRSA) has been reported worldwide. The present study genotyped nMMRSA isolates obtained from hospitals in two cities in Brazil. The hospital isolates displayed pulsed-field gel electrophoresis (PFGE) patterns that were similar to those of the USA100 (ST5-SCCmecII) and USA 800 (ST5-SCCmecIV) strains, which are related to the New York/Japan and paediatric clones, respectively. Carriage of SCCmecIV and the classification by multilocus sequence typing (MLST) of a representative of this PFGE pattern in clonal complex 5 (CC5) confirmed the genetic relationship of the Brazilian isolates with USA800. The USA800-related Brazilian isolates were responsible for severe nosocomial infections in compromised adults and elderly patients in Brazil. A higher growth rate, an ability to form biofilm on inert polystyrene surfaces and the presence of the egc locus may have contributed, at least in part, to the fitness of these organisms as global nosocomial pathogens.

Compromiso óseo en tres escolares por enfermedad por arañazo de gato / Tree schoolboys with bone compromise caused by cat scratch disease

La enfermedad por arañazo de gato (EAG)es una enfermedad infecciosa, producida por Bartonella henselae, de curso benigno, que se presenta frecuentemente como adenopatía crónica en niños. En un 5 a 25 por ciento se puede manifestar de forma atípica, con compromiso óseo, abdominal, neurológico y oftalmológico. Presentamos 3 casos de EAG de curso atípico, con compromiso óseo confirmado con cintigrafía ósea y serología positiva para Bartonella henselae. Después de tratamiento antibiótico se obtuvo completa mejoría clínica.

Espectro clínico de la preeclampsia: estudio comparativo de sus diversos grados de severidad / Clinical spectrum of preeclampsia: comparative study of different grades of severity

Objetivo: Comparar los resultados maternos y perinatales en embarazadas que cursaron con preeclampsia (PE) en sus diversas presentaciones en el período 2001 -2005. Material y Método: Estudio retrospectivo de 7.205 partos asistidos en la maternidad del Hospital Clínico de la Universidad de Chile. 204 mujeres presentaron PE/eclampsia, dividiéndose en 3 grupos: PE modera, severa y síndrome de HELLP. Se analizaron las variables clínicas y de laboratorio de la embarazada y del recién nacido. Se compararon estos resultados en los 3 grupos de estudio. Para variables continuas de distribución normal se empleó el análisis de varianza (ANOVA). Para variables categóricas se empleó la tabla de contingencia de Chi2 o la prueba exacta de Fisher. Resultados: 80 mujeres presentaron PE moderada (39,2 por ciento), 114 PE severa (55,8 por ciento) y 10 HELLP (4,9 por ciento). Se observaron diferencias significativas en la vía de parto, edad gestacional, peso del recién nacido, percentil, morbi-mortalidad neonatal, complicaciones maternas médico-quirúrgicas en los grupos de PE severa y HELLP comparados con las PE moderadas. La PE severa tuvo una mayor proteinuria que los otros dos grupos. Así mismo, se observaron también diferencias significativas en el grupo de síndrome de HELLP en los niveles de enzimas hepáticas, LDH y recuento plaquetario en comparación con el grupo de las PE moderadas y severas. Conclusión: La PE es una entidad clínica que puede presentarse en diversos grados de severidad, por lo que su correcta clasificación de acuerdo a criterios clínicos y de laboratorio, es clave para el tratamiento y pronóstico de las pacientes.

Mortalidad y factores de riesgo asociados a depresión cardio-respiratoria prolongada al nacer / Mortality and associated factors of risk to prolonged cardiorespiratory depression when being born

Existe mayor mortalidad y morbilidad entre los recién nacidos (RN) que mantienen una depresión cardiorrespiratoria a los cinco minutos de vida a pesar de las maniobras de reanimación. Objetivos: individualizar los factores de riesgo que se asocian a esta condición. Pacientes y método: se estudian los recién nacidos con Apgar menor o igual a tres en el período de enero 2003 a mayo del 2004. Se separan en dos subgrupos. Aquellos que se recuperan con maniobras de reanimación y aquellos RN que mantienen la depresión cardiorrespiratoria a los cinco minutos . Las variables estudiadas fueron peso de nacimiento, edad gestacional (EG) en semanas, la relación entre EG y peso, edad materna, multiparidad, morbilidad materna, factores fetales y ovulares. Resultados. De un total de 1705 RN, 64 RN presentan Apgar menor o igual a tres al minuto de vida. 22 RN ( 34,4 por ciento) no mejoran con las maniobras se reanimación a los 5 minutos. De las variables estudiadas son estadísticamente significativas para mantener una depresión severa al nacer, el extremo bajo peso de nacimiento, edad gestacional baja y la condición de ser pequeño para la edad gestacional (PEG). La mortalidad en este grupo es significativamentemayor. Conclusión Los RN que mantienen depresión a los cinco minutos tienen un peso de nacimiento y EG significativamente menor que aquellos que se recuperan con las maniobras de reanimación y tienen mortalidad significativamente mas alta.

A high rate of morbidity and mortality is present among newborns that maintain a cardiorespiratorydepression at five minutes of life in spite of resuscitation maneuvers. Therefore, it is important to know whichrisk factors are associated with this condition. In the time period between January 1, 2003 and May 1, 2004 there was a total of 1,705 alive newborns. Of these 64 (3,75 percent)had an Apgar score of three or less at a minute of life. Among these there were 22 newborns (34,4 percent) that did not improve with resuscitation maneuvers at 5 minutes of life. Amongst the studiedfactors stand out that newborns that presented prolonged depression had birth weight and gestational age significantly lower than those who recover with resuscitation maneuvers. The newborns with cardiorespiratory depression at 5 minutes of life havealmost twice the mortality rate of those born depressed but that improve before 5 minutes of life.

Angiosarcoma primario de la mama: reporte de 2 casos clínicos y revisión de la literatura / Primary Angiosarcoma of the breast: report of 2 clinical cases and revision of literature

El angiosarcoma primario de la mama es una neoplasia maligna poco frecuente y de mal pronóstico caracterizada por la presencia de tumores de rápido crecimiento y gran tamaño al momento del diagnóstico, asociado a cambios equimóticos y edematosos de la piel. Reportamos 2 casos correspondientes a mujeres de 45 y 48 años, en las cuales el diagnóstico definitivo fue anatomopatológico. Se presentan los casos y una revisión bibliográfica, haciendo énfasis en los problemas que trae el diagnostico tardío y erróneo.

The Primary Angiosarcoma of the breast is a low frequency malignant neoplasia and poor prognosis characterized by the presence of tumors of fast growth and great size at the time of the diagnosis associated to ecchymotic and edematosous changes of the skin. We present 2 cases corresponding to women between 48 and 72 years, in which the definitive diagnosis was anatomopathological. A bibliographic review and description of thecases was made, enhancing the importance of exhaustive diagnosis procedure.

Constraining the neutrino magnetic moment with antineutrinos from the sun.

We discuss the impact of different solar neutrino data on the spin-flavor-precession (SFP) mechanism of neutrino conversion. We find that, although detailed solar rates and spectra allow the SFP solution as a subleading effect, the recent KamLAND constraint on the solar antineutrino flux places stronger constraints on this mechanism. Moreover, we show that for the case of random magnetic fields inside the Sun, one obtains a more stringent constraint on the neutrino magnetic moment down to the level of mu(nu)< or = few x 10(-12)mu(B), similar to bounds obtained from star cooling.