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1.
Rev. chil. enferm. respir ; 37(3): 211-221, sept. 2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1388149

ABSTRACT

INTRODUCCIÓN: El tabaquismo continúa siendo un problema sanitario en población universitaria y profesionales de la salud. Los kinesiólogos participan en la implementación de programas orientados a la prevención y cese del tabaquismo en la comunidad. El objetivo de este estudio fue explorar la prevalencia de tabaquismo y actitudes sobre consumo de tabaco en estudiantes de kinesiología. MÉTODOS: Estudio de corte transversal realizado en estudiantes de Kinesiología de Concepción (Chile), durante los años 2017 y 2018. Se determinó la conducta y actitudes sobre tabaquismo. Mediante regresión logística se determinó la asociación entre la conducta fumadora y las actitudes sobre tabaquismo. Se consideró un valor de p < 0,05 como estadísticamente significativo. RESULTADOS: Se contestaron 554 cuestionarios. El 57,8% de los estudiantes encuestados declaró no haber fumado nunca, 13 % no haber fumado los últimos 6 meses y 29,4% declaró ser fumador actual. Por su parte, el 99,5% expresó algún grado de acuerdo con que fumar es perjudicial para la salud, lo cual se relacionó con la conducta fumadora (p < 0,0002). En relación a actitudes sobre tabaquismo, comparado a los no fumadores, los fumadores actuales presentan mayor probabilidad de mostrar desacuerdo o indiferencia respecto a actitudes positivas sobre tabaquismo. Principalmente en aquellas acciones que restringen su consumo, venta y divulgación (OR ponderado = 2,43; 95%IC 2,02 - 2,92). CONCLUSIONES: La prevalencia de tabaquismo en estudiantes de Kinesiología de Concepción es del 29,2%. Los estudiantes fumadores expresan una menor aprobación relacionada a intervenciones, actitudes y consecuencias del tabaquismo para la salud comparada con los no fumadores.


INTRODUCTION: Notwithstanding control policies, smoking continues to be a health problem in university students and health professionals, who are responsible for implementing programs oriented to prevention and cessation of smoking in the community. The objective of this study was to explore the prevalence of smoking and attitudes about smoking in physical therapy students. METHODS: Cross-sectional study carried out in students of physical therapy from three universities of Concepción city (Chile), during the years 2017 and 2018. Behavior and attitudes about smoking were evaluated. Association between smoking behavior and attitudes about smoking was determined by logistic regression. A p value < 0.05 was considered statistically significant. RESULTS: 554 questionnaires were answered. 57.8% of respondents had never smoked, 13.0% had not smoked in the last 6 months and 29.4% were current smokers. Moreover 99.5% of respondents stated some degree of agreement that smoking is harmful to health, which was related to smoking behavior (p < 0.0002). In relation to attitudes about smoking, compared to non-smokers, current smokers have a greater chance of showing disagreement or indifference regarding positive attitudes about smoking. Mainly in those actions that restrict tobacco consumption, sale and disclosure (weighted OR = 2.43, 95% CI 2.02 - 2.92). CONCLUSIONS: The prevalence of current smoking in physical therapy students from Concepcion city is 29.2%. Smoking students express lower approval related to interventions, attitudes and consequences of smoking for health compared with non-smokers.


Subject(s)
Humans , Male , Female , Young Adult , Students, Health Occupations/psychology , Tobacco Use Disorder/psychology , Tobacco Use Disorder/epidemiology , Health Knowledge, Attitudes, Practice , Universities , Logistic Models , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires
2.
Rev. chil. obstet. ginecol. (En línea) ; 85(supl.1): S16-S22, set. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138644

ABSTRACT

La pandemia por COVID-19 ha generado un estancamiento mundial en la atención y resolución de todas las patologías graves y crónicas, debido al colapso de los sistemas de salud, a la dificultad de consulta, dada por la disminución de movilidad de las personas, por las cuarentenas establecidas y también por el temor de los pacientes al contagio en los centros de salud. Los enfermos oncológicos han visto canceladas sus atenciones, suspendidos o postergado sus tratamientos y diferidas sus cirugías. Esto no ha sido ajeno a las pacientes con cáncer de mama. En el presente trabajo, se reporta la experiencia de una Unidad de Patología Mamaria de un hospital público de Santiago de Chile y de las acciones realizadas para mantener la continuidad de atención en una comuna con una alta tasa de infección por SARS-CoV-2.


The COVID-19 pandemic has generated a global stagnation in the care and medical treatment of serious and chronic illnesses due to the collapse of the health systems, the difficulty of consulting due to decreased mobility caused by forced quarantines and also because of the fear of infection when attending a health center. Cancer patients have had their medical appointments canceled, their treatments suspended or postponed, and their surgeries delayed. Breast cancer patients have not been the exception. We report the experience of a Breast Pathology Unit of a public hospital in Santiago of Chile, and the actions carried out to maintain continuity of care in a community with a high infection rate of SARS-CoV-2.


Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumonia, Viral/epidemiology , Breast Neoplasms/therapy , Coronavirus Infections/epidemiology , Continuity of Patient Care/organization & administration , Medical Oncology/methods , Pneumonia, Viral/complications , Obstetrics and Gynecology Department, Hospital , Chile , Epidemiology, Descriptive , Prospective Studies , Long-Term Care/methods , Telemedicine , Coronavirus Infections/complications , Betacoronavirus
3.
Allergol. immunopatol ; 47(3): 282-288, mayo-jun. 2019. tab
Article in English | IBECS | ID: ibc-186491

ABSTRACT

Objective: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. Methods: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. Results: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. Conclusions: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost


No disponible


Subject(s)
Humans , Male , Female , Child , Asthma/epidemiology , Adrenal Cortex Hormones/therapeutic use , Cost of Illness , Asthma/economics , Chile/epidemiology , Cohort Studies , Disease Progression , Emergency Medical Services , Follow-Up Studies , Hospitalization , Prospective Studies , Treatment Outcome
4.
Allergol Immunopathol (Madr) ; 47(3): 282-288, 2019.
Article in English | MEDLINE | ID: mdl-30595390

ABSTRACT

OBJECTIVE: To describe potential regional variations in therapies for severe asthma exacerbations in Chilean children and estimate the associated health expenditures. METHODS: Observational prospective cohort study in 14 hospitals over a one-year period. Children five years of age or older were eligible for inclusion. Days with oxygen supply and pharmacological treatments received were recorded from the clinical chart. A basic asthma hospitalization basket was defined in order to estimate the average hospitalization cost for a single patient. Six months after discharge, new visits to the Emergency Room (ER), use of systemic corticosteroids and adherence to the controller treatment were evaluated. RESULTS: 396 patients were enrolled. Patients from the public health system and from the north zone received significantly more days of oxygen, systemic corticosteroids and antibiotics. Great heterogeneity in antibiotic use among the participating hospitals was found, from 0 to 92.3% (ICC 0.34, 95% CI 0.16-0.52). The use of aminophylline, magnesium sulfate and ketamine varied from 0 to 36.4% between the different Pediatric Intensive Care Units (ICC 0.353, 95% CI 0.010-0.608). The average cost per inpatient was of $1910 USD. 290 patients (73.2%) completed the follow-up six months after discharge. 76 patients (26.2%) were not receiving any controller treatment and nearly a fourth had new ER visits and use of systemic corticosteroids due to new asthma exacerbations. CONCLUSIONS: Considerable practice variation in asthma exacerbations treatment was found among the participating hospitals, highlighting the poor outcome of many patients after hospital discharge, with an important health cost.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , Asthma/epidemiology , Cost of Illness , Asthma/drug therapy , Asthma/economics , Child , Chile/epidemiology , Cohort Studies , Disease Progression , Emergency Medical Services , Female , Follow-Up Studies , Hospitalization , Humans , Male , Prospective Studies , Treatment Outcome
5.
Allergol. immunopatol ; 46(6): 533-538, nov.-dic. 2018. tab
Article in English | IBECS | ID: ibc-177891

ABSTRACT

BACKGROUND: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children


No disponible


Subject(s)
Humans , Asthma/epidemiology , Hospitalization/statistics & numerical data , Patient Education as Topic , Observational Study , Adrenal Cortex Hormones/therapeutic use , Asthma/therapy , Caregivers , Disease Progression , Education, Medical, Continuing , Prospective Studies , Patient Compliance
6.
Allergol Immunopathol (Madr) ; 46(6): 533-538, 2018.
Article in English | MEDLINE | ID: mdl-29720350

ABSTRACT

BACKGROUND: Asthma hospitalization rates in Chilean children have increased in the last 14 years, but little is known about the factors associated with this. OBJECTIVE: Describe clinical characteristics of children hospitalized for asthma exacerbation. METHODS: Observational prospective cohort study in 14 hospitals. Over a one-year period, children five years of age or older hospitalized with asthma exacerbation were eligible for inclusion. Parents completed an online questionnaire with questions on demographic information, about asthma, indoor environmental contaminant exposure, comorbidities and beliefs about disease and treatment. Disease control was assessed by the Asthma Control Test. Inhalation technique was observed using a checklist. RESULTS: 396 patients were enrolled. 168 children did not have an established diagnosis of asthma. Only 188 used at least one controller treatment at the time of hospitalization. 208 parents said they believed their child had asthma only when they had an exacerbation and 97 correctly identified inhaled corticosteroids as anti-inflammatory treatment. 342 patients used the wrong spacer and 73 correctly performed all steps of the checklist. CONCLUSIONS: Almost half of the patients were not diagnosed with asthma at the time of hospitalization despite having a medical history suggestive of the disease. In the remaining patients with an established diagnosis of asthma potentially modifiable factors like bad adherence to treatment and poor inhalation technique were found. Implementing a nationwide asthma program including continued medical education for the correct diagnosis and follow up of these patients and asthma education for patients and caregivers is needed to reduce asthma hospitalization rates in Chilean children.


Subject(s)
Asthma/epidemiology , Hospitalization/statistics & numerical data , Patient Education as Topic , Adrenal Cortex Hormones/therapeutic use , Asthma/therapy , Caregivers , Child , Chile/epidemiology , Cohort Studies , Disease Progression , Education, Medical, Continuing , Female , Humans , Male , Patient Compliance , Prospective Studies
7.
Av. odontoestomatol ; 32(2): 83-95, mar.-abr. 2016. ilus, tab
Article in Spanish | IBECS | ID: ibc-152000

ABSTRACT

Uno de los principales éxitos en prostodoncia es la exactitud de la restauración final que garantice la sobrevida de las prótesis, la reproducción precisa de márgenes de la preparación en una impresión es un requisito necesario para lograr una buena calidad marginal. Es por eso que la técnica y material de impresión, así como el manejo de los tejidos periodontales resultan claves en la consecución del éxito. Entender las propiedades década uno de los materiales utilizados durante el proceso de toma de impresión así como el diagnóstico oportuno de la condición periodontal previa (salud, enfermedad, biotipo periodontal) y las técnicas disponibles para la retracción o desplazamiento de los tejidos gingivales, proporcionan al clínico las herramientas necesarias para la toma de decisiones y la consecución de los mejores resultados estéticos y funcionales en prótesis fija. El propósito de esta revisión de tema es proponer una serie de recomendaciones para el clínico restaurador desde el punto de vista periodontal, que le permita establecer protocolos en el diagnóstico, planificación y ejecución de sus casos clínicos, conociendo las actuales técnicas de desplazamiento o retracción gingival y toma de impresión y sus efectos sobre el periodonto (AU)


One of the major successes in prosthodontics is the accuracy of the final restoration to ensure the survival of the prosthesis, the precise reproduction of the preparation margins in impressions is a need for good quality marginal requirement. That’s why the technique and impression materials, as well as the management of periodontal tissues are key in achieving success. Understanding the properties of each of the materials used for the impression making process and the timely diagnosis of previous periodontal condition (health, disease, periodontal biotype), and techniques available to the retraction or displacement of the gingival tissues, provide clinicians the tools necessary for making decisions and achieving the best aesthetic and functional results infixed prosthesis. The purpose of this topic review is to propose a series of recommendations for clinical restorative from the periodontal approach, which to establish protocols for the diagnosis, planning and execution of their clinical cases, knowing the current techniques of gingival displacement and takes impression and its effects on the periodontium (AU)


Subject(s)
Humans , Dental Impression Materials/adverse effects , Periodontium/injuries , Periodontitis/diagnosis , /methods , Gingival Retraction Techniques , Dental Prosthesis
8.
Epidemiol Infect ; 143(12): 2639-47, 2015 Sep.
Article in English | MEDLINE | ID: mdl-25544572

ABSTRACT

We simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3-47·7] and 44% (95% CI 36·4-51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3-49·0) and 36% (95% CI 27·9-44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.


Subject(s)
Infectious Disease Transmission, Patient-to-Professional , Latent Tuberculosis/epidemiology , Models, Statistical , Personnel, Hospital , Tuberculosis, Pulmonary/epidemiology , Tuberculosis, Pulmonary/transmission , Colombia/epidemiology , Computer Simulation , Hospitals/classification , Humans , Incidence , Interferon-gamma Release Tests , Latent Tuberculosis/diagnosis , Prevalence , Risk Assessment/methods , Tuberculin Test , Tuberculosis, Pulmonary/diagnosis
9.
Rev. Fac. Nac. Salud Pública ; 30(1): 45-56, ene.-abr. 2012. tab
Article in Spanish | LILACS, COLNAL | ID: lil-650060

ABSTRACT

OBJETIVO: identificar la percepción de exclusión social y sus dimensiones demográfica, económica, de participación social y política y su asociación con la calidad de vida relacionada con la salud en las personas de 25 a 60 años de la zona nororiental de Medellín - Colombia, 2009. METODOLOGIA: se condujo un estudio transversal de asociación. El tamaño muestral se calculó con un nivel de confianza de 95%, un error de 4,5% y una proporción de 0,28 derivada de la investigación sobre exclusión social realizada en Medellín en el año 2008, para un total de 404 sujetos. La muestra fue obtenida mediante un muestreo probabilístico, por conglomerados, polietápico, proporcional por sexo sin reemplazo. Los datos se analizaron en el software SPSS v.15.0 y StataSE 10. RESULTADOS: el 22,8% de la población se percibió en situación de exclusión social. En la evaluación de la Calidad de vida relacionada con la salud (CVRS) se encontraron altos puntajes en todos los dominios del cuestionario SF-36, presentándose diferencias significativas en los puntajes del Desempeño Físico (p = 0,000), Desempeño Emocional (p = 0,000) y Salud Mental (p = 0,023), teniendo mayores puntajes en estos dominios las personas no excluidas. Conclusiones: los resultados sugieren que la percepción de exclusión social afecta la CVRS y las condiciones individuales de salud pueden incidir en la percepción de exclusión social. Esto puede deberse a que la salud (enfermedad) en sí es un generador de exclusión social o que la prestación de los servicios de salud en el sistema de salud colombiano, haga que las personas enfermas se sientan excluidas.


OBJECTIVE: to identify the perception of social exclusion and its demographic, economic, and sociopolitical participation dimensions as well as its association with the Health-Related Quality of Life (HRQOL) of people aged 25 to 60 living in the northeastern area of Medellin - Colombia, 2009. METHODOLOGY: a cross-sectional study of association was conducted. The sample size was calculated with a confidence level of 95%, an error of 4.5%, and a ratio of 0.28 derived from a study on social exclusion conducted in Medellín in 2008. The study was conducted with a total of 404 subjects. The sample was obtained through a probability, cluster, and multistage sampling that was proportional by sex and had no replacement. The data was analyzed using the SPSS v.15.0 and Stata 10 software. RESULTS: 22.8% of the population was perceived to be in a situation of social exclusion. The assessment of the Health-Related Quality of Life (hrqol) showed high scores in all the domains of the SF-36 questionnaire. Significant differences were observed in role physical (p = 0.000), role emotional (p = 0.000), and Mental Health (p = 0.023) scores. Non-excluded individuals showed higher scores in these domains. CONCLUSIONS: the results suggest that the perception of social exclusion affects HRQOL and individual health conditions may affect the perception of social exclusion. This may be due to the fact that health (disease) in itself generates social exclusion or that the healthcare services in the Colombian health system cause sick people to feel excluded.


Subject(s)
Humans , Quality of Life , Social Justice , Adult , Health Status Disparities , Social Marginalization
10.
Rev. chil. ortop. traumatol ; 50(2): 87-94, 2009. tab, graf
Article in Spanish | LILACS | ID: lil-559497

ABSTRACT

Giant cell tumor (GCT) is a benign, locally aggressive lesion that primarily affect the long bones epiphyses, which represents 5-9 percent of the bone primary tumors. The purpose of this study is to show the Instituto Traumatológico‘s orthopaedic oncology group experience in the treatment of GCT and suggest a scheme of treatment according to Campanacci’s stage. For which a retrospective study was done, that include 112 patients treated from 1987 to 2007. The average time of follow-up was 9, 2 years, most frequent location was the knee region (69 percent). 85 patients (76 percent) were in stage 3 of Campanaci’s classification. We used different surgical alternatives from basic curettage to resection plus reconstruction with prostheses or aloprostheses. Post surgical complications were seen in 16 patients(14 percent). In the follow-up we had 8 pseudoarthrosis, 7 osteosintesis material failure and 3 allograft fractures. Local recurrence was seen in 15 patients (13,3 percent). 3 cases presented pulmonary metastases (2,6 percent). Mean functional evaluation, using Musculo Skeletal Tumor Society (MSTS) score, was 25, 6 points.


El Tumor de Células Gigantes (TCG) óseo es una neoplasia benigna, localmente agresiva, representa entre el 5-9 por ciento de los tumores óseos primarios. El objetivo del estudio fue revisar la experiencia de nuestra Institución en el tratamiento quirúrgico de esta neoplasia y sugerir un esquema de tratamiento según la etapa de Campanacci. Para esto se realizó un estudio retrospectivo que incluyó 112pacientes tratados desde el año 1987 hasta 2007. El tiempo promedio de seguimiento fue de 9,2 años, el tumor se ubicó alrededor de la rodilla en 78 pacientes (69 por ciento). 85 casos (76 por ciento) se encontraban en etapa III de Campanacci. Utilizamos distintas alternativas quirúrgicas desde el curetaje simple a la resección más reconstrucción con prótesis o aloinjerto. Dieciséis pacientes (14 por ciento) presentaron complicaciones post operatorias. A largo plazo hubo 8 pseudoartrosis, 7 fallas del material de osteosíntesis y 3 fracturas del aloinjerto. Recidivaron 15 pacientes (13,3 por ciento). Tres casos presentaron metástasis pulmonares (2,6 por ciento). La evaluación funcional promedio con la escala de la Musculo Skeletal Tumor Sociaty (MSTS) realizada al año del post operatorio, fue de 25,6 puntos.


Subject(s)
Humans , Male , Adult , Female , Bone Neoplasms/surgery , Giant Cell Tumors/surgery , Combined Modality Therapy , Follow-Up Studies , Neoplasm Metastasis , Neoplasm Recurrence, Local , Neoplasm Staging , Bone Neoplasms/pathology , Postoperative Complications , Retrospective Studies , Giant Cell Tumors/pathology
11.
Rev. chil. ortop. traumatol ; 48(2): 56-64, 2007. ilus, tab
Article in Spanish | LILACS | ID: lil-559480

ABSTRACT

Pelvic resection surgeries due to primary bone tumors are infrequent. According to the compromised area we can divide it in three zones, being those who affect the acetabulum the ones with the major functional alterations, pelvic stability and leg length discrepancy. The aim of this study is to present our experience in the surgical management of this type of lesions. From series of 17 patients, eight (47 percent) presented complications, the most frequents was surgical wound infection (23 percent) and deep venous thrombosis (18 percent). 4 patients died (23 percent). The other 13 patients answered the Musculo Skeletal Tumor Society (MSTS) scale being the average score 22,3. One local recurrence appeared in this group. The acceptance of the patients in this kind of surgeries is very good. These surgeries are complex, there is a high rate of complications. They must be performed in centers with a suitable professional and technical equipment.


Las cirugías de resecciones pélvicas por tumores óseos primarios son infrecuentes. Según el área comprometida se divide principalmente en 3 zonas, siendo las que afectan al acetábulo las que producen mayor alteración (funcional, en la estabilidad pélvica y la longitud de las extremidades inferiores). El objetivo de este trabajo es presentar la experiencia del equipo de tumores del Instituto Traumatológico y la Clínica Santa María en el manejo quirúrgico de este tipo de lesiones. Con un total de 17 pacientes, 8 presentaron complicaciones (47 por ciento), la más frecuente fue la infección de herida operatoria (4 pacientes 23 por ciento) y la trombosis venosa profunda (3 pacientes 18 por ciento). Cuatro pacientes (24 por ciento) fallecieron, los 13 restantes respondieron la escala Musculo Skeletal Tumor Society (MSTS) siendo el puntaje promedio de 22,3. Se presentó una recidiva local en este grupo. El grado de aceptación de los pacientes es muy bueno. Deben realizarse en centros con el equipamiento profesional y técnico adecuado para las exigentes y complejas cirugías a realizar.


Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Chondrosarcoma/surgery , Pelvic Bones/surgery , Bone Neoplasms/surgery , Osteosarcoma , Pelvic Bones/pathology , Patient Satisfaction , Postoperative Complications , Retrospective Studies , Time Factors
14.
Clin Exp Immunol ; 137(2): 402-7, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15270859

ABSTRACT

Early diagnosis of neonatal infection has proved problematic due to the inadequacy of currently available laboratory tests. Neonatal sepsis is associated with an increase in plasma-derived cytokine levels, but an increase of a single cytokine cannot identify neonatal sepsis specifically and multiple cytokine levels are required. The time constraints and relatively large volume of plasma required to measure multiple cytokines from newborn infants by conventional enzyme-linked immunosorbent assay (ELISA) techniques is prohibitive. We therefore applied cytometric bead array (CBA) technology for simultaneous measurement of multiple cytokines from a group of 18 term neonates with infection confirmed by culture and a control group. 'Normal' ranges were established for each cytokine from 1-7-, 8-14- and 15-21-day-old newborns. There was no significant change in the levels of cytokines from infants in different control age groups, suggesting that basal cytokine levels are unchanged in the first 3 weeks of life. In the patient groups, however, there was a significant difference in several cytokines between the different age groups. Interleukin (IL)-6, IL-10 and IL-12 were increased significantly in the 1-7-day-old patient group compared to either the 8-14 and 15-21 age group, suggesting that infection in utero is associated with increased levels of these cytokines compared to infection acquired following birth. When individual patient cytokine levels were compared to normal control reference ranges, two patients failed to show significant elevation of any cytokine tested. All other patients showed elevated levels of between one and nine cytokines tested (mean of 4.6). There was no correlation between elevated cytokine levels and types of infective organism or patient age. In conclusion, neonatal sepsis is associated with the elevation of multiple plasma cytokines. The use of CBA kits is a rapid, easy, low sample volume and sensitive method to measure multiple plasma cytokines.


Subject(s)
Cytokines/blood , Sepsis/diagnosis , Biomarkers/blood , Humans , Infant, Newborn , Interleukins/blood , Reagent Kits, Diagnostic , Reference Values
15.
Bol. Hosp. San Juan de Dios ; 48(6): 338-344, nov.-dic. 2001. tab
Article in Spanish | LILACS | ID: lil-310198

ABSTRACT

Se presentan los resultados de un protocolo prospectivo y cooperativo para el tratamiento del sarcoma de Ewing esquelético. Se evaluaron 27 pacientes (16 hombres, 11 mujeres) con rango de edades de 12 a 34 años. Fueron tratados por un equipo multidisciplinario y multicéntrico (Instituto Traumatológico Dr. Teodoro Gebauer e Instituto Nacional del Cáncer Dr. Caupolicán Pardo C. con un esquema protocolizado de quimioterapia, radioterapia y cirugía conservadora. La mediana de observación fue de 5,3; con un seguimiento de 100 por ciento. Se describe la importancia de un tratamiento controlado y de una buena etapificación previa al inicio del protocolo. La localización más frecuente se presentó en fémur proximal y pelvis (48,3 por ciento). En 22 casos (21,4 por ciento) se encontró la forma localizada, sin metástasis. En 11 de ellos el tumor al momento del diagnóstico tenía un tamaño mayor a 8 cm. Cinco de los pacientes presentaron recidiva local después de haber realizado todo el tratamiento. Para la evaluación funcional se usó la escala de Mankin y la MSTS encontrándose que 18 pacientes (66,6 por ciento) tuvieron un resultado excelente o bueno. Para evaluar la sobrevida se utilizó la Tabla actuarial de Kaplan-Meier. Se concluye que se trata de un protocolo que da buenos resultados y que se puede realizar en nuestro país


Subject(s)
Humans , Male , Female , Adolescent , Adult , Bone Neoplasms , Sarcoma, Ewing , Prospective Studies , Clinical Protocols/standards
16.
Bol. Hosp. San Juan de Dios ; 48(6): 345-348, nov.-dic. 2001. ilus
Article in Spanish | LILACS | ID: lil-310199

ABSTRACT

El sarcoma de Ewing es un tumor óseo descrito en 1921 por James Ewing; su origen aún no ha sido aclarad o aunque actualmente se postula un orígen neural. Se encuentra ubidado en el segundo lugar de frecuencia dentro de los tumores óseos primarios malignos, después del osteosarcoma. Comprende alrededor del 10 por ciento de todos los tumores óseos malignos. Es una neoplasia de alto grado de malignidad que se presenta con más frecuencia en la primera década de la vida (5-15 años) particularmente en pacientes de sexo masculino; rara vez se observa en pacientes mayores de 30 años. Su localización más característica corresponde a la región metafisodiafisiaria de los huesos largos (66 por ciento), seguida de los huesos planos (33 por ciento). Se debe hacer el diagnóstico diferencial con: la osteomielitis aguda, osteomielitis crónica reagudizada, granuloma eosinófilo y con el osteosarcoma de células pequeñas. Su diagnóstico es clínico y radiológico, siendo este último elemento de gran importancia. Dentro de la radiología son de utilidad la radiografía simple, el TAC local, el TAC de tórax y el cintigrama óseo. Otros métodos diagnósticos de apoyo son la biopsia, el mielograma, la inmunohistoquímica y la citogenética. En relación a su tratamiento, se utiliza la radioterapia, quimioterapia y la cirugía conservadora


Subject(s)
Humans , Bone Neoplasms , Sarcoma, Ewing , Prognosis
17.
J Cell Biol ; 151(3): 673-84, 2000 Oct 30.
Article in English | MEDLINE | ID: mdl-11062267

ABSTRACT

Many receptors for endocytosis recycle into and out of cells through early endosomes. We now find in dendritic cells that the DEC-205 multilectin receptor targets late endosomes or lysosomes rich in major histocompatibility complex class II (MHC II) products, whereas the homologous macrophage mannose receptor (MMR), as expected, is found in more peripheral endosomes. To analyze this finding, the cytosolic tails of DEC-205 and MMR were fused to the external domain of the CD16 Fcgamma receptor and studied in stable L cell transfectants. The two cytosolic domains each mediated rapid uptake of human immunoglobulin (Ig)G followed by recycling of intact CD16 to the cell surface. However, the DEC-205 tail recycled the CD16 through MHC II-positive late endosomal/lysosomal vacuoles and also mediated a 100-fold increase in antigen presentation. The mechanism of late endosomal targeting, which occurred in the absence of human IgG, involved two functional regions: a membrane-proximal region with a coated pit sequence for uptake, and a distal region with an EDE triad for the unusual deeper targeting. Therefore, the DEC-205 cytosolic domain mediates a new pathway of receptor-mediated endocytosis that entails efficient recycling through late endosomes and a greatly enhanced efficiency of antigen presentation to CD4(+) T cells.


Subject(s)
Antigen Presentation/immunology , Antigens, CD , Dendritic Cells/immunology , Endocytosis , Histocompatibility Antigens Class II/immunology , Lectins, C-Type , Lysosomes/metabolism , Membrane Glycoproteins/immunology , Membrane Glycoproteins/metabolism , Receptors, Cell Surface/immunology , Receptors, Cell Surface/metabolism , Adsorption , Amino Acid Sequence , Animals , CD4-Positive T-Lymphocytes/immunology , Cells, Cultured , Dendritic Cells/cytology , Dendritic Cells/metabolism , Endosomes/metabolism , Flow Cytometry , Humans , Immunoglobulin G/immunology , Immunoglobulin G/metabolism , L Cells , Membrane Glycoproteins/chemistry , Membrane Glycoproteins/genetics , Mice , Minor Histocompatibility Antigens , Molecular Sequence Data , Receptors, Cell Surface/chemistry , Receptors, Cell Surface/genetics , Receptors, IgG/genetics , Receptors, IgG/immunology , Receptors, IgG/metabolism , Recombinant Fusion Proteins/immunology , Recombinant Fusion Proteins/metabolism , Sequence Alignment , Transfection
18.
Science ; 286(5441): 952-4, 1999 Oct 29.
Article in English | MEDLINE | ID: mdl-10542149

ABSTRACT

Peptide-major histocompatibility complex protein complexes (pMHCs) on antigen-presenting cells (APCs) are central to T cell activation. Within minutes of peptide-specific T cells interacting with APCs, pMHCs on APCs formed clusters at the site of T cell contact. Thereafter, these clusters were acquired by T cells and internalized through T cell receptor-mediated endocytosis. During this process, T cells became sensitive to peptide-specific lysis by neighboring T cells (fratricide). This form of immunoregulation could explain the "exhaustion" of T cell responses that is induced by high viral loads and may serve to down-regulate immune responses.


Subject(s)
Endocytosis , Histocompatibility Antigens/immunology , Peptides/immunology , Receptors, Antigen, T-Cell/immunology , T-Lymphocytes/immunology , Animals , Cell Line , Drosophila , Flow Cytometry , Macromolecular Substances , Recombinant Fusion Proteins/genetics , Recombinant Fusion Proteins/immunology , T-Lymphocytes/metabolism , T-Lymphocytes, Cytotoxic/immunology
19.
J Immunol ; 163(3): 1133-42, 1999 Aug 01.
Article in English | MEDLINE | ID: mdl-10415007

ABSTRACT

We investigate, here, the mechanism of the costimulatory signals for CD8 T cell activation and confirm that costimulation signals via CD28 do not appear to be required to initiate proliferation, but provide survival signals for CD8 T cells activated by TCR ligation. We show also that IL-6 and TNF-alpha can provide alternative costimulatory survival signals. IL-6 and TNF-alpha costimulate naive CD8 T cells cultured on plate-bound anti-CD3 in the absence of CD28 ligation. They act directly on sorted CD8-positive T cells. They also costimulate naive CD8 T cells from Rag-2-deficient mice, bearing transgenic TCRs for HY, which lack memory cells, a potential source of IL-2 secretion upon activation. IL-6 and TNF-alpha provide costimulation to naive CD8 T cells from CD28, IL-2, or IL-2Ralpha-deficient mice, and thus function in the absence of the B7-CD28 and IL-2 costimulatory pathways. The CD8 T cell generated via the anti-CD3 plus IL-6 and TNF-alpha pathway have effector function in that they express strong cytolytic activity on Ag-specific targets. They secrete only very small amounts of any of the cytokines tested upon restimulation with peptide-loaded APC. The ability of the naive CD8 T cells to respond to TCR ligation and costimulatory signals from IL-6 and TNF-alpha provides a novel pathway that can substitute for signals from CD4 helper cells or professional APC. This may be significant in the response to viral Ags, which can be potentially expressed on the surface of any class I MHC-expressing cell.


Subject(s)
CD28 Antigens/physiology , CD8-Positive T-Lymphocytes/immunology , Interleukin-2/physiology , Lymphocyte Activation , Adjuvants, Immunologic/physiology , Animals , Antibodies, Monoclonal/pharmacology , CD28 Antigens/immunology , CD3 Complex/immunology , CD8-Positive T-Lymphocytes/chemistry , CD8-Positive T-Lymphocytes/cytology , Cell Survival/immunology , Cells, Cultured , DNA-Binding Proteins/genetics , Drug Synergism , Fluoresceins/analysis , Fluorescent Dyes/analysis , H-Y Antigen/immunology , Indicators and Reagents , Interleukin-6/physiology , Mice , Mice, SCID , Mice, Transgenic , Propidium/analysis , Receptors, Antigen, T-Cell, alpha-beta/genetics , Signal Transduction/immunology , Succinimides/analysis , Tumor Necrosis Factor-alpha/physiology
20.
Bol. Hosp. San Juan de Dios ; 45(3): 168-74, mayo-jun. 1998. ilus, tab
Article in Spanish | LILACS | ID: lil-216517

ABSTRACT

Se presentan los resultados de un protocolo prospectivo de tratamiento combinado de quimioterapia y cirugía conservadora para el osteosarcoma clásico en etapas I A a II B (Enneking). Se evaluaron 64 pacientes, 39 hombres y 25 mujeres, con edades en rango de 14-60 años. La mediana de seguimiento fue de 40 meses (mínimo 20 y máximo de 72). Todos los pacientes fueron tratados con: doxorrubicina, cisplatino, ifosfamida y mesna en tres ciclos preoperatorios y ciclos postoperatorios, realizándose cirugía conservadora de reemplazos protésicos, alo o autoinjertos. La sobrevida actuarial fue de 60,2 por ciento a los 72 meses de observación. Se describe la relación del diagnóstico tardío con la incidencia de metástasis y sobrevida. Se enfatiza el buen resultado funcional y se recomienda el uso del protocolo presentado


Subject(s)
Humans , Female , Male , Adult , Middle Aged , Drug Therapy, Combination , Osteosarcoma/drug therapy , Disabled Persons , Disease-Free Survival , Osteosarcoma/classification , Osteosarcoma/diagnosis , Osteosarcoma/surgery , Prospective Studies , Treatment Outcome
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