Perfil epidemiológico de pacientes que asisten a neurorrehabilitación / Epidemiological profile of patients attending neurorehabilitation

Antecedentes y objetivo Los avances tecnológicos en el diagnóstico y tratamiento han reducido la mortalidad de muchas enfermedades, observándose como consecuencia un aumento de la población con discapacidad, por lo que la rehabilitación se vuelve una herramienta fundamental. En este contexto muchas instituciones cuentan con unidades de neurorrehabilitación que permiten potenciar la recuperación funcional de sus pacientes, sin embargo, hasta la fecha no se dispone de información del perfil epidemiológico de esta población, por lo que el objetivo de esta investigación es describir las características epidemiológicas y clínicas de los pacientes hospitalizados que asisten a unidades de neurorrehabilitación. Materiales y método Análisis de variables demográficas y clínicas de sujetos atendidos durante el año 2018 en un hospital chileno. Resultados En 2018 asistieron 152 pacientes a la unidad de neurorrehabilitación, la mayoría de sexo masculino (61,2%), con una mediana de edad de 62 años y principalmente pertenecientes al sistema privado de salud (51,0%). El 57,9% de los pacientes tuvo un diagnóstico relacionado con el sistema nervioso, donde el accidente cerebrovascular fue el más común; los diagnósticos relacionados con el sistema osteomuscular ocuparon el 13,2%, mientras que los diagnósticos clasificados como «otros sistemas» completaron el restante 28,9%. La mediana de permanencia en el hospital fue de 34 días, de los cuales 13 incluyeron asistencia la unidad de neurorrehabilitación, lo que significó un aumento del 53% en su funcionalidad mediada a través del FIM. Conclusiones Este es el primer estudio epidemiológico que describe a pacientes hospitalizados que asisten a una la unidad de neuro rehabilitación, siendo en su mayoría, pero no exclusivamente, adultos mayores con diagnósticos neurológicos, quienes destinaron más de un tercio de su hospitalización a rehabilitación aumentando considerablemente su funcionalidad (AU)

Background and objective Technological advances in diagnosis and treatment has reduced the mortality of many diseases, however, because of this the number of people with disabilities has increased. In this context, many health institutions have a neuro rehabilitation unit to enhance functional recovery in their patients. However, to date there is no information about the epidemiological profile of this population, so the objective of this research is to describe the characteristics of hospitalized patients attending neuro rehabilitation units. Materials and Method Analysis of demographic and clinical variables of subjects hospitalized during 2018 in a Chilean hospital. Results 152 patients attended the neuro rehabilitation gym in 2018. They were mostly male (61.2%), with a median age of 62 years and mainly under the private health system (51.0%). Of the subjects, 57.9%had a nervous system diagnosis, of which stroke was the most common, a musculoskeletal system diagnosis accounted for 13.2%, while those classified under “other system” comprised the last 28.9%. The median stay in the hospital was 34 days, of which 13 included attending the neuro rehabilitation unit, this meant a 53% increase in their functionality measured through the FIM. Conclusions This is the first epidemiological study to describe hospitalized patients attending a neuro-rehabilitation unit, most, but not exclusively, older adults with neurological diagnoses, who allocated more than a third of their hospitalization time to rehabilitation, considerably increasing their functionality (AU)

Timber identification of Autranella, Baillonella and Tieghemella in the taxonomically challenging Sapotaceae family.

BACKGROUND: To enforce timber import laws and perform timber species identification, the identity of the botanical species must be well-defined. Since the Sapotaceae family is known as a taxonomically challenging family, we focus in this study on the four most valuable Sapotaceae timber species from tropical Africa: Autranella congolensis (De Wild.) A.Chev., Baillonella toxisperma Pierre, Tieghemella africana Pierre and Tieghemella heckelii (A.Chev.) Pierre ex Dubard. The wood anatomical characteristic fiber lumen fraction and Direct Analysis in Real Time-Time of Flight Mass Spectrometry (DART-TOFMS) were used to differentiate the four species and to make inferences on species delineation and taxonomic identity. RESULTS: We observed differences in the fiber lumen fraction measurements and discerned two groups: (1) A. congolensis and B. toxisperma, and (2) T. africana and T. heckelii. In addition, all Mann-Whitney U comparisons and differences in distributions (Kolmogorov-Smirnov) for the fiber lumen fraction measurements were significant between all species. When permutating the data between species within those two groups, significant differences were still found between the species within those groups. This could indicate that the fiber lumen fraction is not diagnostic to discern the species. DART-TOFMS analysis showed that A. congolensis and B. toxisperma have distinct chemotypes, while T. heckelii and T. africana have remarkably similar chemotypes. CONCLUSIONS: Based on our observations of similar chemotype and weakly differentiated fiber lumen ratio, we support an alternative taxonomic hypothesis that considers Tieghemella monotypic, because of the strong resemblance between T. heckelii and T. africana. Larger sample sizes and further research is required to develop methodology for the identification of these species. A taxonomic study utilizing molecular genetics would be beneficial to assess the status of the genus and the species limits. This could have implications towards their potential inclusion on CITES appendices if there is ever need for them to be listed. If Tieghemella africana and T. heckelii remain two distinct species, they should both be listed. Screening agents should be aware that the morphological and chemical differences between T. africana and T. heckelii are minimal.

COVID-19 en el paciente pediátrico / COVID-19 in the pediatric patient

Resumen Este documento fue preparado (en junio de 2020) por y para los profesionales médicos (clínicos y proveedores de salud), y está disponible públicamente para propósitos de recomendaciones relacionada con pacientes pediátricos y enfermedad por coronavirus 2019 (COVID-19). Según datos disponibles hasta la fecha, los niños de todas las edades pueden contraer la COVID-19; sin embargo, tienen mejor pronóstico que los adultos, siendo pocos los casos graves reportados, y los casos leves se recuperan en 1-2 semanas después del inicio de la enfermedad. El objetivo de este documento es aportar peculiaridades que consideramos importantes para el diagnóstico y tratamiento. Debido a los cambios en la actual situación epidemiológica se pueden modificar algunos conceptos y acciones, por lo que la información aquí contenida debe ser adaptada a cada paciente, basada en el juicio clínico, necesidades del paciente y recursos disponibles.

Abstract This document was prepared (June 2020) by and for medical professionals (clinicians and health providers), and it is available as a guideline for pediatric patients with coronavirus disease 2019 (COVID-19). So far, according to available data although children of all ages can acquire COVID-19, they have better outcome than adults, with a little proportion of severe disease, and in mild cases they have a 1 to 2-week recovery after the beginning of the infection. The objective of this document is to provide particularities that we consider important for diagnosis and treatment. Owe to the changing epidemiological situation some concepts and actions can change, so this information must be adapted to each specific case, based on the clinical judgement according to patient requirements and available resources.

Comparación del consumo de edulcorantes no nutritivos con estado nutricional en embarazadas chilenas / Comparison of non-nutritive sweetener consumption and nutritional status among pregnant Chileans

INTRODUCCIÓN: El consumo de edulcorantes no calóricos (ENC) se ha incrementado en todos los grupos etarios, sin embargo, no se ha cuantificado su ingesta en embarazadas OBJETIVO: Determinar la ingesta y comparar el consumo de ENC según el estado nutricional en embarazadas chilenas. MATERIAL Y MÉTODOS: Estudio descriptivo, se entrevistaron a embarazadas de las ciudades de Santiago y Concepción. A cada embarazada se le aplicó una encuesta de frecuencia de consumo semanal de alimentos con ENC para determinar la ingesta de ellos, y se les realizó una evaluación nutricional utilizando la información del carné de control de la embarazada. RESULTADOS: Se evaluaron 601 embarazadas, 98% consume ENC, ninguna de ellas sobrepasa la ingesta diaria admitida (IDA) para ningún ENC. Las bebidas y jugos con ENC presentan la mayor penetración de productos con ENC de la dieta. Al comparar según estado nutricional, no se encontraron diferencia en el consumo de los ENC. Al comparar solo las bebidas y jugos con ENC con ciclamato las embarazadas obesas consumen significativamente más. CONCLUSIÓN: No se observó diferencias según estado nutricional cuando se analiza de manera global, al analizar por grupos de alimentos el mayor consumo se observo en bebidas con ciclamato en las embarazadas con obesidad.

INTRODUCTION: Consumption of non-caloric sweeteners (NCS) has increased in all age groups; however, intake in pregnant women has not been quantified. OBJECTIVE: To determine the intake of NCS and compare consumption by nutritional status among pregnant Chileans. MATERIAL AND METHODS: Pregnant women from the cities of Santiago and Concepción were interviewed as part of a descriptive study. Each pregnant woman was given a frequency survey of weekly food consumption with NCS to determine intake, and a nutritional evaluation was carried out using information from the pregnant woman's check up form. RESULTS: 601 pregnant women were evaluated, 98% consumed NCS, none of them exceeded the accepted daily intake (ADI) for any NCS. Beverages and juices with NCS presented the highest proportions of NCS in the diet. When comparing nutritional status, no difference was found in the consumption of NCS. When comparing only beverages and juices with NCS, obese pregnant women consumed significantly more cyclamate compared to non-obese women. CONCLUSION: No differences according to nutritional status were observed when analyzed globally, when analyzing by food groups the highest consumption was observed in beverages with cyclamate among obese pregnant women.

The evolutionary history of the goby Elacatinus puncticulatus in the tropical eastern pacific: Effects of habitat discontinuities and local environmental variability.

Habitat discontinuities, temperature gradients, upwelling systems, and ocean currents, gyres and fronts, can affect distributions of species with narrow environmental tolerance or motility and influence the dispersal of pelagic larvae, with effects ranging from the isolation of adjacent populations to connections between them. The coast of the Tropical Eastern Pacific (TEP) is a highly dynamic environment, with various large gyres and upwelling systems, alternating currents and large rocky-habitat discontinuities, which may greatly influence the genetic connectivity of populations in different parts of the coast. Elacatinus puncticulatus is a cryptic, shallow-living goby that is distributed along the continental shore of virtually the entire TEP, which makes it a good model for testing the influence of these environmental characteristics in the molecular evolution of widespread species in this region. A multilocus phylogeny was used to evaluate the influence of habitat gaps, and oceanographic processes in the evolutionary history of E. puncticulatus throughout its geographical range in the TEP. Two well-supported allopatric clades (one with two allopatric subclades) were recovered, the geographic distribution of which does not correspond to any previously proposed major biogeographic provinces. These populations show strong genetic structure and substantial genetic distances between clades and sub-clades (cytb 0.8-7.3%), with divergence times between them ranging from 0.53 to 4.88 Mya, and recent population expansions dated at 170-130 Kya. The ancestral area of all populations appears to be the Gulf of Panama, while several isolation events have formed the phylogeographic patterns evident in this species. Local and regional oceanographic processes as well as habitat discontinuities have shaped the distribution patterns of the genetic lineages along the continental TEP. Large genetic distances, high genetic differentiation, and the results of species-tree and phylogenetic analyses indicate that E. puncticulatus comprises a complex of three allopatric species with an unusual geographic arrangement.

Luxación expuesta de rodilla: ¿Qué hemos aprendido en los últimos 20 años? / Open knee dislocations: what have we learn about it in the last 20 years?

INTRODUCCIÓN: La luxación expuesta de rodilla es compleja, de incidencia baja con grandes secuelas funcionales. Existen escasos reportes de series en la literatura relativos a su manejo y resultados. OBJETIVO: El objetivo de este trabajo fue describir los resultados obtenidos de todos los pacientes con luxación expuesta de rodilla tratados durante las últimas dos décadas en nuestro hospital bajo un mismo estándar de tratamiento. MÉTODO: Estudio descriptivo retrospectivo en una serie quirúrgica de 11 pacientes con luxación expuesta de rodilla, tratados entre 1994 y 2015. Todos fueron estudiados y manejados según esquema estandarizado: Angiografía/ angioTC, aseo quirúrgico, fijador externo y reparación neurovascular en casos necesarios. Revisión de registros clínicos e imagenológicos consignando datos demográficos, lesiones concomitantes, número y tipo de cirugías, y complicaciones asociadas. Seguimiento promedio fue de 10,7 años con evaluación mediante encuesta funcionales SF-12/IKDC durante el mes de marzo de 2015. RESULTADOS: Diez pacientes eran hombres, 1 mujeres. Edad promedio al accidente 38,6 años. Mecanismo lesional de alta energía; como referencia la clasificación de Schenck, 1 lesión III-M, 4 tipo IV y los 6 restantes una tipo V. 4 lesiones vasculares (36.4%) y 7 lesiones neurológicas (63.6%). Tratamiento definitivo consistió en 4 reconstrucciones ligamentarias, 2 prótesis, 3 artrodesis y 2 amputaciones supracondíleas. Evaluaciones funcionales dieron como resultados un puntaje promedio de 37 y 48,5 para SF-12 físico y mental respectivamente, y de 44,1 para IKDC. CONCLUSIÓN: La luxación expuesta de rodilla es una lesión infrecuente, muy compleja, asociada a accidentes de alta energía, con complicaciones severas, lo que determina resultados funcionales relativamente malos. La estandarización permite sistematizar las distintas etapas de atención, racionalizar los recursos disponibles evitando la improvisación en momentos críticos, lo que podría incidir en la obtención de resultados.

INTRODUCTION: Open knee dislocation is a complex lesion of low incidence and large functional sequelae. There are few series reports in the literature regarding its management and outcomes. OBJECTIVE: Describe the results obtained from all patients with open knee dislocation treated during the last two decades in our hospital under the same treatment standard. METHOD: Retrospective descriptive study in a surgical series of 11 patients with open knee dislocation, treated between 1994 and 2015. All were studied and managed according to a standardized protocol: Angiography/angioCT, surgical debridement, external fixation and neurovascular repair in necessary cases. Review of clinical and imaging records, recording demographic data, concomitant injuries, number and type of surgeries and associated complications. Average follow-up was 10.7 years, with an evaluation through functional surveys SF-12/IKDC during March 2015. RESULTS: 10 patients were men, 1 woman. Average age at accident 38.6 years. High-energy trauma mechanism of injury; Schenk classification as reference, 1 lesion type III-M, 4 type IV and the remaining 6 type V. 4 vascular lesions (41.7%) and 7 neurological lesions (63.6%). Definitive treatment consisted in 4 ligamentous reconstructions, 2 prostheses, 3 arthrodesis and 3 supracondylar amputations. Functional evaluations showed an average score of 37 and 48.5 for SF-12 physical and mental respectively, and 44.1 for IKDC. CONCLUSION: Open knee dislocation is a rare, very complex, associated to high-energy trauma, with severe complications, which determines relatively poor functional outcomes. Standardization allows to systematize the different stages of attention and rationalize available resources avoiding improvisation at critical moments, which could affect the results.

Comparison of species classification models of mass spectrometry data: Kernel Discriminant Analysis vs Random Forest; A case study of Afrormosia (Pericopsis elata (Harms) Meeuwen).

RATIONALE: The genus Pericopsis includes four tree species of which only Pericopsis elata (Harms) Meeuwen is of commercial interest. Enforcement officers might have difficulties discerning this CITES-listed species from some other tropical African timber species. Therefore, we tested several methods to separate and identify these species rapidly in order to enable customs officials to uncover illegal trade. In this study, two classification methods using Direct Analysis in Real Time (DART™) ionization coupled with Time-of-Flight Mass Spectrometry (DART-TOFMS) data to discern between several species are presented. METHODS: Metabolome profiles were collected using DART™ ionization coupled with TOFMS analysis of heartwood specimens of all four Pericopsis species and Haplormosia monophylla (Harms) Harms, Dalbergia melanoxylon Guill. & Perr. Harms, and Milicia excelsa (Welw.) C.C. Berg. In total, 95 specimens were analysed and the spectra evaluated. Kernel Discriminant Analysis (KDA) and Random Forest classification were used to discern the species. RESULTS: DART-TOFMS spectra obtained from wood slivers and post-processing analysis using KDA and Random Forest classification separated Pericopsis elata from the other Pericopsis taxa and its lookalike timbers Haplormosia monophylla, Milicia excelsa, and Dalbergia melanoxylon. Only 50 ions were needed to achieve the highest accuracy. CONCLUSIONS: DART-TOFMS spectra of the taxa were reproducible and the results of the chemometric analysis provided comparable accuracy. Haplormosia monophylla was visually distinguished based on the heatmap and was excluded from further analysis. Both classification methods, KDA and Random Forest, were capable of distinguishing Pericopsis elata from the other Pericopsis taxa, Milicia excelsa, and Dalbergia melanoxylon, timbers that are commonly traded.

Megacolon tóxico en una paciente con colitis seudomembranosa / Toxic megacolon in a patient with colitis pseudomembranous

La colitis seudomembranosa es una patología relacionada con el uso de antibióticos. En raras ocasiones, evoluciona a megacolon tóxico que podría requerir resolución quirúrgica. Comunicamos el caso de una mujer de 22 años, que recibió amoxicilina/ácido clavulánico unos días antes de la consulta. Presentó diarrea, fiebre y vómitos. Radiografía y tomografía computarizada de abdomen: distensión de colon derecho >6 cm. Toxina para Clostridium: positiva. Comienza con el tratamiento médico y requiere cirugía por megacolon tóxico. El megacolon tóxico es una complicación infrecuente de la colitis seudomembranosa. Es rara en pacientes jóvenes y sin comorbilidades. Se llega al diagnóstico mediante los criterios de Jalan. La tasa de mortalidad se aproxima al 70%. Se debe mantener alto nivel de alerta ante signos de toxicidad sistémica y la dilatación colónica es diagnóstica de la entidad. El uso indiscriminado de antibióticos constituye un serio factor de riesgo.(AU)

Pseudomembranous colitis is a condition associated with the use of antibiotics. On rare occasions, it evolves to toxic megacolon which may require surgical resolution. We report the case of a 22-year-old woman who received amoxicillin/clavulanic acid a few days before the consultation. She referred diarrhea, fever and vomiting. Radiography and computed tomography of abdomen: distension of the right colon >6 cm. Clostridium toxin: positive. Medical treatment is administered and surgery is needed for toxic megacolon. Toxic megacolon is an infrequent complication of pseudomembranous colitis. It is rare in young patients without comorbidities. The diagnosis is reached using the Jalan criteria. The mortality rate approaches 70%. A high level of alertness should be maintained for signs of systemic toxicity and colonic dilation is diagnostic of the entity. Indiscriminate use of antibiotics is a serious risk factor.(AU)

Early Steroid Withdrawal in Recipients of a Kidney Transplant From a Living Donor: Experience of a Single Mexican Center.

BACKGROUND: Early steroid withdrawal (ESW) can improve lipid and hemodynamic profiles without severe acute rejection (AR) events in renal transplant patients. Our objective was to evaluate the effects of ESW on the frequency and severity of AR. METHODS: A randomized, open-label, controlled clinical trial was performed on renal transplant recipients with a follow-up of 12 months. In the ESW group, patients were selected for corticosteroid treatment withdrawal on the fifth day post transplantation. In the Control group, patients continued with steroid treatment. All patients were over 18 years of age with panel reactive antibody (PRA) class I and II HLA <20%. RESULTS: In total, 71 patients, 37 in the ESW group (52.1%) and 34 in the Control group (47.9%), had comparable AR incidences at the end of the follow-up (16% vs 15%) (NS) (RR = 1.20, 95% CI = 0.32-3.33). Although renal graft survival was similar between the ESW and Control groups (87% vs 94%), renal function was superior in the ESW group (85 vs 75 mL/min). Additionally, hypertension was less frequent in the ESW group (3% vs 35%), requiring the use of fewer antihypertensives (8% vs 50%). CONCLUSIONS: ESW was also associated with better blood pressure control and similar AR risk. The ESW group exhibited stable renal function.

Estabilidad abdominolumbopélvica y equilibrio como predictores de la incidencia de lesiones musculoesqueléticas en estudiantes de danza: Un estudio piloto / Core stability and balance as predictors of the incidence of musculoskeletal injures in dance students: A pilot study

Objetivo: Determinar si la estabilidad abdominolumbopélvica (EALP) y el equilibrio actúan como predictores de lesiones musculoesqueléticas en estudiantes de danza de Santiago de Chile. Material y método: El estudio es de carácter no experimental, descriptivo, correlacional y prospectivo. Se seleccionó a 67 estudiantes de danza de 3 universidades de Santiago de Chile basándose en los criterios de inclusión/exclusión preestablecidos. Posteriormente fueron evaluados mediante el Star-Excursion-Balance-Test (SEBT) para el equilibrio, y mediante un test propuesto por McGill para la EALP. Se realizó un seguimiento semanal durante 3 meses para detectar la incidencia de lesiones, completando el estudio 42 participantes. Mediante análisis estadístico, se determinó la relación entre desempeño de los test e incidencia de lesiones. Resultados: Se registraron 100 lesiones con una media de 2,38±1,14 por estudiante. El SEBT muestra una media de 3,73±0,26; 3,72±0,3 y 7,45±0,55 para la extremidad inferior izquierda, derecha y el total respectivamente. El test de McGill muestra una media de 373,14±126,43 s y 93,29±31,61 s para la suma y promedio respectivamente. La correlación de la variable lesión con la variable rendimiento muestra significación estadística para el SEBT de la extremidad izquierda, derecha y total (p=0,012; p=0,049; p=0,020, respectivamente). No se observa significación estadística para la evaluación de EALP. Conclusiones: El equilibrio actúa como predictor de lesiones en esta población. Sin embargo, son necesarios más estudios que puedan aislar otros factores que pudiesen estar determinando la incidencia de lesiones

Objective: To determine if core stability and balance act as predictors of musculoskeletal injuries dance students Santiago de Chile. Material and methods: The study is non-experimental, descriptive, correlational and prospective. A total of 67 dance students were selected of 3 universities of Santiago de Chile based on inclusion/exclusion preset. Later were evaluated by the Star-Excursion-Balance-Test (SEBT) for balance, and by a McGill proposed for core stability test. Weekly monitoring was conducted for 3 months to detect the incidence of injury, 42 participants completing the study. Through statistical analysis, the relationship between test performance and incidence of lesions was determined. Results: A total of 100 lesions were recorded with a mean of 2.38 ± 1.14 by student. The SEBT shows an average of 3.73 ± 0.26, 3.72 ± 0.3 and 7.45 ± 0.55 for the bottom left, right and total limb respectively. McGill's test shows an average of 373.14 ± 126.43 seconds and 93.29 ± 31.61 seconds for the sum and average respectively. The correlation between the performance variable injury variable shows overall SEBT statistical significance for the left limb and right (P = .12, P.49, P = .20, respectively). No statistical significance for assessing core stability observed. Conclusions: The balance acts as a predictor of injury in this population. However, more studies that can isolate other factors that could be determining the incidence of injury are needed

Tumour cell lysate-loaded dendritic cell vaccine induces biochemical and memory immune response in castration-resistant prostate cancer patients.

BACKGROUND: Recently, we produced a tumour antigen-presenting cells (TAPCells) vaccine using a melanoma cell lysate, called TRIMEL, as an antigen source and an activation factor. Tumour antigen-presenting cells induced immunological responses and increased melanoma patient survival. Herein, we investigated the effect of TAPCells loaded with prostate cancer cell lysates (PCCL) as an antigen source, and TRIMEL as a dendritic cell (DC) activation factor; which were co-injected with the Concholepas concholepas haemocyanin (CCH) as an adjuvant on castration-resistant prostate cancer (CRPC) patients. METHODS: The lysate mix capacity, for inducing T-cell activation, was analysed by flow cytometry and Elispot. Delayed-type hypersensitivity (DTH) reaction against PCCL, frequency of CD8(+) memory T cells (Tm) in blood and prostate-specific antigen (PSA) levels in serum were measured in treated patients. RESULTS: The lysate mix induced functional mature DCs that were capable of activating PCCL-specific T cells. No relevant adverse reactions were observed. Six out of 14 patients showed a significant decrease in levels of PSA. DTH(+) patients showed a prolonged PSA doubling-time after treatment. Expansion of functional central and effector CD8(+) Tm were detected. CONCLUSION: Treatment of CRPC patients with lysate-loaded TAPCells and CCH as an adjuvant is safe: generating biochemical and memory immune responses. However, the limited number of cases requires confirmation in a phase II clinical trial.

The acromion and its different forms / El acromion y sus diferentes formas

The morphology of the acromion, its relation to the coracoid process and the supraglenoid tubercle is important in the determination of the dimension of the subacromial space, considering that the variations of these structures can promote pathologies such as impingement syndrome of the subacromial space. There is little information on the different dimensions and forms of the acromion. We studied in 36 scapulae at the museum of the Anatomy Unit, Universidad de La Frontera, the following parameters: length, denseness, width, anterior projection, distance acromiocoracoid and acromion supraglenoid. According to this form, the type was qualified in acromion type I (plane) type II (curved) and type III (hooked). The averages of the variable length, anterior projection were statistically significant in the acromion of the right side. In relation to its classification 8 percent was type I, 50 percent type II, and 42 percent type III. The anatomically obtained information will allow health professionals to access new morphometric information regarding the acromion and use it as a base for future pathology investigation of the upper arm.

La morfología del acromion, sus relaciones con el proceso coracoides y tubérculo supraglenoídeo es importante en la determinación de la dimensión del espacio subacromial, considerando que las variaciones de estas estructuras pueden provocar patologías como el síndrome del pinzamiento del espacio subacromial. Para aportar información de las diferentes dimensiones y forma del acromion, hemos estudiado en 36 escápulas del museo de la Unidad de Anatomía, Universidad de La Frontera, los siguientes parámetros: longitud, espesor, ancho, proyección anterior, distancia acromiocoracoidea y acromio supraglenoídea. De acuerdo a su forma se clasificaron en acromion tipo I (plano), tipo II (curvo), tipo III (ganchoso). Los promedios de las variables longitud, proyección anterior, fueron estadísticamente significativas en el acromion del lado derecho. En relación a su clasificación, el 8 por ciento fue de tipo I, 50 por ciento tipo II, 42 por ciento tipo III. Los datos anatómicos obtenidos permitirán a los profesionales de la salud contar con nuevos antecedentes morfométricos del acromion pudiendo servir de base para futuros estudios de patologías del miembro superior.

Risk factors for Banff borderline acute rejection in protocol biopsies and effect on renal graft function.

INTRODUCTION: The interpretation and handling of Banff borderline acute rejection observed in protocol biopsies from patients with stable renal function continues to be controversial. Our objective was to identify the risk factors for borderline acute rejection on 1-year protocol biopsies and to evaluate their effect on renal graft function after 2 years' follow-up. METHODS: We included 82 kidney transplant recipients (KTR), who underwent 1-year protocol biopsies with normal or stable graft function. All KTR had follow-up of at least 2 years posttransplantation. We formed three groups: (1) KTR with a normal biopsy, (2) KTR with borderline changes, and (3) KTR with interstitial fibrosis/tubular atrophy (IF/TA). We searched for risk factors related to borderline injury. The main outcome to evaluate was renal function at 1 month, at protocol biopsy, and 2 years posttransplant. RESULTS: The 82 patients included in this study showed no differences in immunosuppression, gender, etiology of renal failure, or percentage of panel-reactive antibodies. The risk factors associated with borderline lesions were: at least one biopsy due to allograft dysfunction and acute rejection events during the first year posttransplant (P = .011 and P = .021, respectively). Increased serum creatinine and estimated glomerular filtration rate decline were greater among the borderline lesion than the normal group, but similar to patients with IF/TA. CONCLUSION: Renal function decline was greater among borderline and IF/TA groups. However, the sum of insults, and not only the borderline injury itself, produces greater declines in renal function with greater risk for graft loss.

[Tungiasis affects a chilean turist]. / Tungiasis afecta a un turista chileno.

Tungiasis is a cutaneous ectoparasitosis caused by the female sand flea Tunga penetrans whose higher prevalence occurs in Sub-Saharan Africa, South América and the Caribbean. We report a case of a 23 year old chilean male who presented dermal lesions suggestive of tungiasis on his return from Brazil. The diagnosis was confirmed by biopsy, identifying the arthropod and an egg from one of the lesions. The natural history, co-morbidities and treatment options were reviewed.

Duplicación de la vesícula biliar: vesícula doble de tipo Y operada: reporte de un caso / Gallbladder duplication: report of one case

The duplication of the gallbladder is a rare malformation, seen in one every 3.000 necropsies. It is detected preoperatively by abdominal ultrasound. We report a 28 years old female consulting for abdominal pain. An abdominal ultrasound showed the presence of cholelithiasis and a complete septum in the gallbladder lumen. During surgery, a distended and inflamed gallbladder was found with a septum that divided it in two parts, and one biliary stone. There was also a double cystic duct. The pathological study confirmed the gallbladder duplication with inflammation.

La patología de la vesícula biliar (VB) ocupa un lugar importante en nuestro país. Las anomalías congénitas más frecuentes incluyen alteraciones en los conductos biliares, arteria cística e infrecuentemente duplicaciones de la VB, con una incidencia de 1 en 3.000-4.000 autopsias. Esta anomalía congénita puede ser detectada preoperatoriamente por estudios imagenológicos, principalmente ecotomografía, siendo en el pasado un hallazgo quirúrgico. El diagnóstico diferencial de la duplicación vesicular incluye la vesícula con fondo plegado o gorro frigio, divertículos vesiculares, quistes de las vías biliares extra-hepáticas y la vesícula bilobulada o septada. Comunicamos el caso de una duplicación vesicular de tipo Y, en una mujer con diagnóstico ecotomográfico, la cual fue operada de forma clásica.

Tungiasis afecta a un turista chileno / Tungiasis affects a chilean turist

Tungiasis is a cutaneous ectoparasitosis caused by the female sand flea Tunga penetrans whose higher prevalence occurs in Sub-Saharan África, South América and the Caribbean. We report a case of a 23 year old chilean male who presented dermal lesions suggestive of tungiasis on his return from Brazil. The diagnosis was confirmed by biopsy, identifying the arthropod and an egg from one of the lesions. The natural history, co-morbidities and treatment options were reviewed.

La tungiasis es una ectoparasitosis cutánea producida por la hembra de la pulga de arena Tunga penetrans, cuya mayor prevalencia ocurre en África Sub-sahariana, Sudamérica y el Caribe. Comunicamos el caso de un chileno de 23 años que viajó a Brasil y que a su regreso presentó lesiones dérmicas sugerentes de tungiasis. El diagnóstico fue confirmado por una biopsia identificando el artrópodo y un huevo en una de las lesiones. Se revisa la historia natural, las co-morbilidades asociadas y alternativas de tratamiento.

Factores antinutricionales presentes en el arroz pilado crudo / Anti nutritional factors present in raw, polished rice

El objetivo de este artículo fue investigar la presencia de los factores antinutricionales en el arroz pilado crudo, tales como inhibidor de la tripsina, la lectina y el ácido fítico. El estudio es parte del proyecto de investigación de la equivalencia sustancial del arroz mejorado genéticamente AS 10-7-6 y CPM 10-4-6, desarrollado por el Centro de Investigaciones de Biología Molecular y Celular de la Universidad de Costa Rica, CIBCM, en Costa Rica. La metodología utilizada fue revisión de literatura, disponible en revistas nacionales e internacionales y consulta a expertos. Se encontró que la detección de dichos antinutrientes en el arroz pilado es muy baja en arroz crudo y es aún menor en el arroz cocido, ya que la lectina y el inhibidor de la tripsina son sensibles al calor y se inactivan al cocinar el alimento. En estudios realizados el arroz mejorado genéticamente llamado Libertylink, no se encontraron diferencias en el contenido de ácido fítico al compararlo con el par convencional. Además, se encontró que el inhibidor de la tripsina sólo está presente en la granza; la lectina no fue detectada en ninguna de las presentaciones del arroz. Por lo que al considerar la información bibliográfica y los resultados del arroz LibertyLink, se concluye que la presencia de antinutrientes es baja o ninguna, en el arroz pilado de las líneas mejoradas genéticamente en estudio.

The purpose of this study was to research the presence of anti-nutrient factors such as the trypsin inhibitor, lectin and phytic acid all in raw, polished rice. This review is part of a larger research project on the substantial equivalence of AS 10-7-6 and CPM 10-4-6, genetically-modified rice developed by the Cellular and Molecular Biology Research Center (CIBCM) at the University of Costa Rica. The methodology used was a review of the literature both in national as well as in international journals and also experts´ opinion. Our results show that detection of these anti-nutrient factors in rice is low and it is very low in polished rice; the reason is that lectin and trypsin inhibitors are heat-sensitive and they are deactivated when cooked. Some studies done on genetically-modified Libertylink rice found no difference in phytic acid content when compared to non-modified rice. The trypsin inhibitor is detected only on the embryo and bran layers; lectin was not detected in any of the different rice presentations. In conclusion, according to the review done in the literature as well as the study done on Libertylink rice, it can be said that the presence of anti-nutrients in rice is expected to be low or absent in genetically-modified rice lines.

Frecuencia de aspergiloma en pacientes con antecedente de tuberculosis, hemoptisis, radiografía anormal y baciloscopía negativa / Frequency of aspergilloma in patients with history of tuberculosis, hemoptysis, abnormal chest x-ray films and negative sputum smears

Objetivo: Determinar la frecuencia de aspergilomas en pacientes con antecedentes de tuberculosis pulmonar curada,hemoptisis, radiografía de tórax anormal y BK negativo. Materiales y métodos: Se enroló 28 pacientes entre diciembrede 2002 y septiembre de 2004 en el Hospital Nacional Hipólito Unanue de Lima y Hospital Belén de Trujillo. A los pacientesevaluados en el Hospital Belén se les solicitó tres muestras de esputo, seriadas y consecutivas, mientras que lospacientes evaluados en el Hospital Nacional Hipólito Unanue y que fueron sometidos a cirugía de tórax, se les colectóuna porción de la pieza quirúrgica tisular pulmonar. Ambas muestras biológicas fueron cultivadas en agar sabourauddextrosa - cloramfenicol 0,05 por ciento e incubados a temperatura ambiente y 37 °C por 15 días. A todos los pacientes se lesextrajo 5 mL de sangre total para realizar la prueba de inmunodifusión contra Aspergillus sp. Resultados: La frecuenciade aspergiloma fue de 43 por ciento (12/28). Se identificó por cultivo Aspergillus fumigatus en cinco casos, Aspergillus sp endos, A. niger en uno, A. flavus en uno y en dos casos positivos por serología no se logró aislar el hongo. En los dospacientes donde se identificó A. niger, no se detectó presencia de anticuerpos contra Aspergillus sp. En el HospitalBelén la frecuencia de aspergiloma fue 39 por ciento (7/18) y en el Hospital Hipólito Unanue 50 por ciento (5/10). Conclusiones: Lafrecuencia de aspergiloma en los 28 pacientes investigados en ambos hospitales fue de 43 por ciento y el principal agenteetiológico fue A. fumigatus.

Objective: To determine the frequency of aspergilloma in patients with history of cured pulmonary tuberculosis, hemoptysis, abnormal chest X-ray films, and negative sputum smears for acid-fast bacilli. Materials and methods: 28 patients were enrolled between December 2002 and September 2004 in Hipolito Unanue National Hospital in Lima and Belen Hospital in Trujillo. Patients from Belen Hospital had three serial and consecutive sputum samples taken, while those patients from Hipolito Unanue Hospital who underwent thoracic surgery had a portion of the surgical specimen collected. Both biological samples were cultured in Sabouraud dextrose agar – 0,05% chloramphenicol, and they were incubated at room temperature and at 37° C for 15 days. All patients had a 5-mL blood sample taken in order to perform immunodifusion tests for Aspergillus sp. Results: The frequency of aspergilloma was 43%) (12/28). Aspergillus fumigatus was identified in cultures in five cases, Aspergillus sp. was identified in two cases, A. niger in one, A. flavus in one, and in two cases reported as positive for serological tests the fungus could not be isolated. In the two patients in whom A. niger was identified, no presence of antibodies against Aspergillus sp. was detected. In Belen Hospital the frequency of aspergilloma was 39% (7/18), and in Hipolito Unanue Hospital it was 50% (5/10). Conclusions: Aspergilloma frequency in 28 patients studied in both hospitals was 43%, and the main etiological agent was A. fumigatus.

The effect of malarial infection on maternal-fetal outcome in Ecuador.

OBJECTIVE: To describe maternal and fetal outcome among pregnancies complicated with malarial infection. METHODS: Charts of pregnancies complicated with malarial infection were reviewed. Parasital etiology and maternal/fetal data was analyzed. RESULTS: During the year 2001, at the Enrique C. Sotomayor Obstetrics and Gynecology Hospital, Guayaquil-Ecuador, 80 pregnancies complicated with malarial infection were admitted for treatment. This rendered an incidence of 2.1 per 1,000 live births (80/37,579). Mean maternal age was 25.2 +/- 6.7 years and the 19-29 age group was the most frequently affected (50%). On admittance, fever, chills, jaundice and anemia was present in 97.5%, 78.8%, 38.8% and 60% respectively. Falciparum was the most frequently presenting species (56.3%). Patients admitted at < 20 weeks gestation (n = 17) had a 76.5% and 82.4% abortion and adverse fetal outcome rate respectively. Among those admitted at 20-36 weeks (n = 55) the rates for preterm birth, intrauterine fetal death, low birthweight (LBW) and small-for-gestational age (SGA) were 34.5%, 11%, 40.8% and 48.9% respectively. Among patients admitted > 36 weeks, 87.5% (7/8) ended in a live term delivery. Adolescents presented a higher rate of anemia and SGA neonates. The overall (n = 80) abortion, preterm delivery and intrauterine fetal demise rates were 16.3%, 25% and 8.8% respectively. Chloroquine effectively treated 98.8% of cases and there was one maternal death due to falciparum infection. CONCLUSIONS: In this Ecuadorian population, malarial infection complicating gestation was associated to adverse maternal-fetal outcome, which was more evident among teenagers and pregnancies presenting malaria at an earlier gestational age.

Rab23 is an essential negative regulator of the mouse Sonic hedgehog signalling pathway.

The mouse open brain (opb) and Sonic hedgehog (Shh) genes have opposing roles in neural patterning: opb is required for dorsal cell types and Shh is required for ventral cell types in the spinal cord. Here we show that opb acts downstream of Shh. Ventral cell types that are absent in Shh mutants, including the floor plate, are present in Shh opb double mutants. The organization of ventral cell types in Shh opb double mutants reveals that Shh-independent mechanisms can pattern the neural tube along its dorsal-ventral axis. We cloned opb by a map-based approach and found that it encodes Rab23, a member of the Rab family of vesicle transport proteins. The data indicate that dorsalizing signals activate transcription of Rab23 in order to silence the Shh pathway in dorsal neural cells.