Control of Mycobacterium tuberculosis growth by activated natural killer cells.

We characterized the underlying mechanisms by which glutathione (GSH)-enhanced natural killer (NK) cells inhibit the growth of Mycobacterium tuberculosis (M. tb) inside human monocytes. We observed that in healthy individuals, treatment of NK cells with N-acetyl cysteine (NAC), a GSH prodrug in conjunction with cytokines such as interleukin (IL)-2 + IL-12, resulted in enhanced expression of NK cytotoxic ligands (FasL and CD40L) with concomitant stasis in the intracellular growth of M. tb. Neutralization of FasL and CD40L in IL-2 + IL-12 + NAC-treated NK cells resulted in abrogation in the growth inhibition of M. tb inside monocytes. Importantly, we observed that the levels of GSH are decreased significantly in NK cells derived from individuals with HIV infection compared to healthy subjects, and this decrease correlated with a several-fold increase in the growth of M. tb inside monocytes. This study describes a novel innate defence mechanism adopted by NK cells to control M. tb infection.

Duración de las licencias médicas FONASA por trastornos mentales y del comportamiento / Analysis of sick leaves due to mental and behavioral problems

Background: In Chile, the number of sick leaves due to mental health problems has systematically increased in recent years. Aim: To perform an analysis of sick leaves due to mental problems managed by the Fondo Nacional de Salud (FONASA) during 2008. Material and Methods: Analysis of all sick leaves awarded during 2008for mental or behavioral problems, that were managed at FONASA. A negative binomial regression, was performed to predict the effects of different variables on the total duration of sick leaves. Results: A total of546,477 sick leaves were awarded to 198,752 individuals (2.27per subject). The mean duration of each leave was 15.6 days. Summing all leaves, the lapse off work was 98 ± 96 days (median 65 days). Women had longer leaves than men. The type of medical leave, occupation, working for private or public institutions, economic activity and diagnosis were significantly associated with duration of time off work. Conclusions: Sick leaves for mental problems are prolonged and related to gender and socioeconomic variables.

Estudio de la salud cardiovascular en el estado Lara (escel 2008): metodología del proyecto y perfil de la muestra estudiada / The cardiovascular health study in state Lara (escel 2008): methodology of the project and the sample profile

Existen pocos estudios de factores de riesgo para enfermedad cardiovascular en América Latina y El Caribe. ESCEL-2008 estudió la distribución de factores de riesgo para enfermedad cardiovascular en población urbana, de 15 o más años de edad. Estado Lara, Venezuela. En este artículo se presenta la metodología para obtener una muestra probabilística a nivel poblacional y describir sus características demográficas. Estudio transversal de base poblacional. El censo poblacional del Estado Lara 2001 correspondió al marco muestral. La población estuvo ubicaba en 9 municipios. 58 parroquias y 2.300 centros poblados. De estos últimos, 36 urbanos (mayor e igual 2500 habitantes). La muestra probabilística obtenida mediante entrevista cara a cara y muestreo por conglomerados en cuatro etapas, combinando selección aleatoria simple y sistemática de las unidades sin reemplazo. 1294 personas encuestadas con tasa de respuesta de 77,3%. Muestra con un porcentaje superior de mujeres (66,5%) con respecto a la población proyectada a 2007 (51,2%), así como, mayor porcentaje de personas en las franjas superiores de edad. En cuanto al grado de escolaridad, aproximadamente 20% tuvo nivel universitario completo; 3,7% de los jefes de familia son analfabetos, valor inferior al de madres (15,6%) y otro miembro familiar (13,2%). Hubo una buena tasa de respuesta para la metodología aplicada, que permitió obtener una muestra representativa de la población diana y podría servir para estudiar de manera eficiente la distribución de factores de riesgo de ECV en otros lugares de América Latina y El Caribe.

There are few studies at the population level of risk factors for cardiovascular disease (CVD) in Latin America and the Caribbean. The principal objetive of ESCEL 2008 Project is to study the distribution of risk factors for cardiovascular disease in the urban population of Lara State, Venezuela, ages 15 or more years. This article aims to present the methodology used to obtain a probability sample at the population level and to describe its demographic charactéristics. Cross-sectional population based study. The population census of 2001 in Lara State was used as the sampling frame. According to this, the population was located in 9 municipalities, 58 parishes and 2.300 population centres, Of the latter, 36 were urban (2.500 inhabitants or more). The probability sample underwent face to face interviews and sampling by clusters in four stages, combining simple, systematic random selection of units without replacement. 1.294 people were surveyed, with a response rate of 77.3%. The sample was composed of a higher percentage of women than projected for the population to 2007, 66.5% versus 51.2%, as well as a higher percentage of people in the upper age groups. Approximately one of every five respondents including heads of households, mothers, or other interviewees had a completed university education. 3.7% of the heads of households were illiterate, which is lower tham among mothers and other family members, 15.6% and 13.2%, respectively. The response rate for the applied methodology can be considered good. given the high level of anxiety about safety in the urban population. Differences in the distribution of age and sex in the sample relative to 2007 projections, required adjustments to the age and sex distribution in order to maintain representativeness of the population. The described methodology allowed us to obtain a representative sample of the target population, and could be used to study the distribution of risk factors for cardiovascular disease.

Safety and immunogenicity of one dose of MenACWY-CRM, an investigational quadrivalent meningococcal glycoconjugate vaccine, when administered to adolescents concomitantly or sequentially with Tdap and HPV vaccines.

This Phase III study evaluates an investigational quadrivalent meningococcal CRM(197) conjugate vaccine, MenACWY-CRM (Novartis Vaccines), when administered concomitantly or sequentially with two other recommended adolescent vaccines; combined tetanus, reduced diphtheria and acellular pertussis (Tdap), and human papillomavirus (HPV) vaccine. In this single-centre study, 1620 subjects 11-18 years of age, were randomized to three groups (1:1:1) to receive MenACWY-CRM concomitantly or sequentially with Tdap and HPV. Meningococcal serogroup-specific serum bactericidal assay using human complement (hSBA), and antibodies to Tdap antigens and HPV virus-like particles were determined before and 1 month after study vaccinations. Proportions of subjects with hSBA titres > or =1:8 for all four meningococcal serogroups (A, C, W-135, Y) were non-inferior for both concomitant and sequential administration. Immune responses to Tdap and HPV antigens were comparable when these vaccines were given alone or concomitantly with MenACWY-CRM. All vaccines were well tolerated; concomitant or sequential administration did not increase reactogenicity. MenACWY-CRM was well tolerated and immunogenic in subjects 11-18 years of age, with comparable immune responses to the four serogroups when given alone or concomitantly with Tdap or HPV antigens. This is the first demonstration that these currently recommended adolescent vaccines could be administered concomitantly without causing increased reactogenicity.

Perfil epidemiológico del paciente con antígeno prostático específico sobre 4 ng/mL: Región del Bío Bío, Chile / Epidemiological profile of the patient with prostate specific antigen over 4 ng/mL: Bio Bio Region, Chile

Objetivo: Describir el perfil epidemiológico de una muestra de pacientes beneficiarios del Servicio de Salud Bío Bío con examen de antígeno prostático sobre 4 ng/mL. Método: Se realizó un estudio transversal descriptivo donde se revisaron 436 fichas clínicas de pacientes con niveles APE > 4,0 ng/ml determinado en el Laboratorio Clínico del Hospital Dr. Víctor Ríos Ruiz, entre enero y junio del año 2006. También se obtuvo información a partir de los certificados de defunción y de anatomía patológica. Resultados: El 42,4 por ciento pertenecía a la comuna de Los Ángeles y el 57,6 por ciento restante se distribuye homogéneamente dentro de la región de Bío Bío. El promedio de edad de los pacientes fue de 72 años (31 a 98 años). El 75,6 por ciento pertenece a los grupos A y B del Fondo Nacional de Atención de Salud (FONASA), habiendo 10 por ciento sin afiliación conocida. El 63,4 por ciento presentaba hipertensión arterial. El 24,8 por ciento tuvo como diagnóstico cáncer de próstata (CaP) y el 58,2 por ciento hiperplasia benigna prostática. El 58,26 por ciento de los pacientes tuvo un valor de APE entre 4,00 a 10,00 ng/ml, el 34,59 por ciento entre 10,01 a 50,00 ng/ml y el 7,57por ciento un valor de APE >50,00 ng/ml. Conclusiones: El mayor porcentaje de los pacientes se concentra en la ciudad de Los Ángeles, siendo la mayoría del segmento A y B del fondo nacional de salud. La edad promedio fue de 72 años. La hipertensión arterial, la diabetes mellitus y el cáncer de próstata fueron las patologías más prevalentes en estos pacientes.

Objective: To describe the epidemiologic profile of a sample of patient beneficiaries of the Bio Bio Health Service with prostate specific antigen (PSA) up 4 ng/mL. Method: A descriptive cross-sectional study was made between January and June of 2006, where436 clinical histories of patients with levels APE up 4.0 ng/ml were reviewed. Also information from certificates of death and pathological anatomy was obtained. Results: The 42.4 percent belonged of Los Angeles province and the rest were distributed homogenous within Bio Bio region. The average of age of the patients was of 72 years old (31 to 98 years). The 75.6 percent belong to the groups A and B of the National Found of Health Attention (FONASA), being a 10.0 percent without well-known affiliation. The 63.4 percent presented arterial hypertension. The 24.8 percent present prostate cancer diagnostic (CaP) and the 58.2 percent had benign prostatic hyperplasia. 58.26 percent of the patients had a value of PSA between 4.0 to.10.0 ng/ml, the 34.59 percent between 10.01 to 50.00 ng/ml and the 7.57 percent a value of APE>50.00 ng/ml. Conclusions: The larger percentages of the patients live in the urban area of Los Angeles city, belonging most of the segment A and B of the National Found of Health Attention (FONASA). The average age was of 72 years. The hypertension arterial, the diabetes mellitus and the prostate cancer were the most prevalent pathologies in these patients.

Insuficiencia cardíaca en hospitales chilenos: resultados del Registro Nacional de Insuficiencia Cardíaca, Grupo ICARO / Cardiac failure in Chilean hospitals: results of the National Registry of Heart Failure, ICARO

Background: Heart failure (HF) is a major public health problem. In Chile hospitalized patients due to HF have not been characterized. Aim: To evaluate clinical profile and outcome of patients hospitalized for heart failure in Chilean hospitals. Patients and Methods: Prospective registry of 14 centers. Patients hospitalized for HF in functional class III and IV were included. Epidemiological and clinical data, functional class, type of presentation, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. Results: Three hundred seventy two patients aged 69±13 years old, 59 percent men, were assessed. The main etiologies of HF were ischemic in 31.6 percent, hypertensive in 35.2 percent, valvular in 14.9 percent and idiopathic in 7.4 percent. There was a history of hypertension 69 percent, diabetes in 35 percent, myocardial infarction in 22 percent, atrial fibrillation (AF) in 28 percent. The presentation form of HF was chronic decompensated in 86 percent, acute in 12 percent, refractory in 2 percent. The causes of decompensation were non compliance with diet or medical prescriptions in 28 percent, infections in 22 percent and AF 17 percent. ECG showed AF in 36 percent and left bundle branch block in 16 percent. Echocardiography was performed in 52 percent of the patients, 69 percent had left ventricular ejection fraction <40 percent. On admission, 39 percent received angiotensin converting enzyme (ACE) inhibitors, 15 percent beta-blocker, 25 percent digoxin, 16 percent spironolactone and 53 percent furosemide. The mean hospital stay was 11±10 days and mortality was 4.5 percent. Conclusions: The elderly is the age group most commonly admitted to hospital due to HF. The main etiologies were ischemic and hypertensive. The main causes for decompensations were noncompliance with diet or medical prescriptions and infections. A significant proportion had a relatively well preserved ventricular systolic function (Rev Méd Chile 2004; 132: 655-62).

Cirugía Urológica Ambulatoria: experiencia Hospital Ramón Barros Luco-Trudeau, Servicio de Salud Metropolitano Sur / Outpatient urological surgery: experience Hospital Barros Luco-Trudeau. Servicio de Salud Metropolitano Sur

La cirugía ambulatoria ha experimentado un gran desarrollo en la última década, pues permite un rápido reintegro a la vida familiar y laboral luego de una intervención quirúrgica, una disminución de la ansiedad del paciente al acortar su estadía en el centro hospitalario y un aumento en la eficiencia de los servicios de salud, al incurrir en menores gastos en recursos humanos e infraestructura, todo esto, manteniendo un índice de complicaciones inmediatas y tardías, similares al registrado con el paciente hospitalizado.En enero de 2001, se organiza la Unidad de Cirugía Ambulatoria, en el Hospital Barros Luco-Trudeau, protocolizándose el tipo de pacientes y patologías susceptibles de operar bajo esta modalidad. De enero de 2001 a julio de 2002, se operaron en la Unidad de Cirugía Ambulatoria, 313 pacientes, constituyendo el 12 porciento de las cirugías del servicio durante ese período. Se suspendió el 10,8 porciento de los pacientes citados debido a causas médicas y administrativas. Las patologías más frecuentes fueron fimosis (37 porciento), varicocele (25 porciento), quiste epididimario (13 porciento), hidrocele (9 porciento), orquiectomía (9 porciento). El tiempo promedio de estadía fue de 5,5 h, requiriendo hospitalización el 1,5 porciento de los pacientes operados. Dentro del seguimiento, destaca la infección de la herida operatoria en 4 porciento de los pacientes.La cirugía ambulatoria es una alternativa segura, que supone una mínima alteración al modo de vida del paciente, disminuye costos hospitalarios, con morbilidad similar a la que se presenta con el paciente hospitalizado. Para obtener los resultados expuestos, ha resultado fundamental una atención protocolizada, la adecuada selección del paciente y su patología.

Dimorfismo sexual en la pigmentación de la piel, color de ojos y pelo y presencia de pecas en adolescentes chilenos en dos estratos socioeconómicos / Sexual dimorphism in skin, eye and hair color and the presence of freckles in Chilean teenagers from two socioeconomic strata

BACKGROUND: The risk of skin cancer is correlated with skin colour. Pigmentation protects against the effects of UV radiation. AIM: To study skin, eyes and hair colour in Chilean teenagers. MATERIAL AND METHODS: The constitutive skin, hair and eyes colour and the presence of freckles was studied in 716 teenagers (416 females) of a low socio economical level and in 307 teenagers (155 females) of a high socio economical level. RESULTS: The proportion of foreign surnames was higher in the high stratum and we only found aboriginal surnames in the low stratum. The females of the lower stratum presented lighter skin than males. This difference was not observed in the higher stratum. We did not find significant differences in the eye colour between sexes, however, adolescents from the high stratum presented lighter eye colour. Females had lighter hair colour than males in both strata, also, we found lighter hair colour in the high stratum. We did not find significant differences in the presence of freckles between strata, but, the proportion of females with freckles was higher than that of males in both strata. CONCLUSIONS: Our results may identify different groups of people, within the Chilean population, with different susceptibility to the effects of ultraviolet radiation.

[Analysis of the situation of occupational health in Chile]. / Análisis de la situación de la salud ocupacional en Chile.

The authors make a critical analysis of the Occupational Health in Chile based on the conclusions obtained from a multidisciplinary workshop, attended by professionals of this area. The method used was strategic planning, exposing the weaknesses, strengths and expectations regarding the health reality of the region. A profile of the type of professionals that should participate in the programs was also discussed, elaborating a work plan that should reflect the future development in this area, as well as pointing out the role of the University in the work plan and analysing the future of Occupational Health.

Cavopulmonary connection in repair of atrioventricular septal defect with small right ventricle.

Between February 1991 and May 1992, 9 patients with a nonrestrictive inlet ventricular septal defect or complete atrioventricular septal defect and hypoplasia of the right ventricle underwent successful two-ventricle correction incorporating a bidirectional cavopulmonary anastomosis. Despite a satisfactory early postoperative course, large serous pleural effusions developed in 5 of them between 2 and 6 weeks after operation. Serial echocardiography showed an evolution of flow patterns in the superior vena cava from marked systolic reversal immediately after operation to nearly continuous forward flow into both pulmonary arteries about 6 weeks later. This pattern was consistent with the transition from cardiac-dependent to respiratory-dependent caval flow. The development of pleural effusions appeared to coincide with the loss of systolic caval flow reversal and resolved after establishment of a predominantly respiratory-dependent flow pattern.

Tricuspid atresia with common arterial trunk: surgical palliation in a neonate.

A two-week-old asymptomatic baby was diagnosed by cross-sectional and Doppler ultrasound to have tricuspid atresia with a common arterial trunk. Successful surgical palliation was undertaken at 17 days of age, by disconnection of the pulmonary arteries from the trunk, and creation of an aortopulmonary shunt. There are no known previous reports of surgical palliation of this lesion.

Cáncer vesical primario y embarazo / Bladder primary carcinoma and pregnancy

Se presenta el caso de una paciente de 28 años, embarazada, con hematuria, en la que se confirma el diagnóstico de cáncer vesical, que correspondería al duodécimo informe de la literatura mundial. Se enfatiza la importancia del estudio adecuado de la hematuria en el embarazo. Se hacen alcances acerca de la escasa frecuencia de la asociación de cáncer vesical y embarazo