The Emerging Pathogen Candida metapsilosis: Biological Aspects, Virulence Factors, Diagnosis, and Treatment.

Fungal infections represent a constant and growing menace to public health. This concern is due to the emergence of new fungal species and the increase in antifungal drug resistance. Mycoses caused by Candida species are among the most common nosocomial infections and are associated with high mortality rates when the infection affects deep-seated organs. Candida metapsilosis is part of the Candida parapsilosis complex and has been described as part of the oral microbiota of healthy individuals. Within the complex, this species is considered the least virulent; however, the prevalence has been increasing in recent years, as well as an increment in the resistance to some antifungal drugs. One of the main concerns of candidiasis caused by this species is the wide range of clinical manifestations, ranging from tissue colonization to superficial infections, and in more severe cases it can spread, which makes diagnosis and treatment difficult. The study of virulence factors of this species is limited, however, proteomic comparisons between species indicate that virulence factors in this species could be similar to those already described for C. albicans. However, differences may exist, taking into account changes in the lifestyle of the species. Here, we provide a detailed review of the current literature about this organism, the caused disease, and some sharing aspects with other members of the complex, focusing on its biology, virulence factors, the host-fungus interaction, the identification, diagnosis, and treatment of infection.

Suspensión frontal con aponeurosis temporal en paciente con ptosis palpebral traumática recidivante crónica / Frontal suspension with temporal aponeurosis in a patient with chronic recurrent traumatic eyelid ptosis

La ptosis palpebral es una de las patologías más frecuentes en la consulta de oftalmología, tanto en urgencias como en el ámbito ambulatorio. El trauma del párpado superior puede provocar ptosis o retracción o una combinación de ambos. En este tipo de ptosis palpebral, su resolución mediante tratamiento quirúrgico, existiendo múltiples alternativas de procedimientos que se decidirá de acuerdo con la causas que las originan, así como la severidad de la ptosis. En este trabajo es a propósito de un caso clínico en el cual nos encontramos una paciente con ptosis palpebral traumática recidivante, utilizándose suspensión frontal con aponeurosis de músculo temporal, realizándose una variación de la técnica de Crawford disminuyendo la probabilidad de nueva recidiva

Palpebral ptosis is one of the most frequent pathologies in the ophthalmology consultation, both in the emergency room and in the outpatient setting Trauma to the upper eyelid can cause ptosis or retraction or a combination of both. In this type of eyelid ptosis its resolution by surgical treatment, there are multiple alternatives of procedures that will be decided according to the causes that originate them, as well as the severity of the ptosis, in this work is about a clinical case in which we find a patient with Recurrent Traumatic Palpebral Ptosis, using frontal suspension with aponeurosis of temporal muscle, performing a variation of the Crawford Technique decreasing the probability of recurrence.

Mannose-modified hyaluronic acid nanocapsules for the targeting of tumor-associated macrophages.

Tumor-associated macrophages (TAMs), a class of immune cells that play a key role in tumor immunosuppression, are recognized as important targets to improve cancer prognosis and treatment. Consequently, the engineering of drug delivery nanocarriers that can reach TAMs has acquired special relevance. This work describes the development and biological evaluation of a panel of hyaluronic acid (HA) nanocapsules (NCs), with different compositions and prepared by different techniques, designed to target macrophages. The results showed that plain HA NCs did not significantly influence the polarization of M0 and M2-like macrophages towards an M1-like pro-inflammatory phenotype; however, the chemical functionalization of HA with mannose (HA-Man) led to a significant increase of NCs uptake by M2 macrophages in vitro and to an improved biodistribution in a MN/MNCA1 fibrosarcoma mouse model with high infiltration of TAMs. These functionalized HA-Man NCs showed a higher accumulation in the tumor compared to non-modified HA NCs. Finally, the pre-administration of the liposomal liver occupying agent Nanoprimer™ further increased the accumulation of the HA-Man NCs in the tumor. This work highlights the promise shown by the HA-Man NCs to target TAMs and thus provides new options for the development of nanomedicine and immunotherapy-based cancer treatments.

Assessing Prescriber Behavior with a Clinical Decision Support Tool to Prevent Drug-Induced Long QT Syndrome.

OBJECTIVE: Clinical decision support (CDS) alerts built into the electronic health record (EHR) have the potential to reduce the risk of drug-induced long QT syndrome (diLQTS) in susceptible patients. However, the degree to which providers incorporate this information into prescription behavior and the impact on patient outcomes is often unknown. METHODS: We examined provider response data over a period from October 8, 2016 until November 8, 2018 for a CDS alert deployed within the EHR from a 13-hospital integrated health care system that fires when a patient with a QTc ≥ 500 ms within the past 14 days is prescribed a known QT-prolonging medication. We used multivariate generalized estimating equations to analyze the impact of therapeutic alternatives, relative risk of diLQTS for specific medications, and patient characteristics on provider response to the CDS and overall patient mortality. RESULTS: The CDS alert fired 15,002 times for 7,510 patients for which the most common response (51.0%) was to override the alert and order the culprit medication. In multivariate models, we found that patient age, relative risk of diLQTS, and presence of alternative agents were significant predictors of adherence to the CDS alerts and that nonadherence itself was a predictor of mortality. Risk of diLQTS and presence of an alternative agent are major factors in provider adherence to a CDS to prevent diLQTS; however, provider nonadherence was associated with a decreased risk of mortality. CONCLUSION: Surrogate endpoints, such as provider adherence, can be useful measures of CDS value but attention to hard outcomes, such as mortality, is likely needed.

Estudio sobre Automedicación y Ansiedad en Endodoncia / Study on Self-Medication and Anxiety in Endodontis

Objetivos. Los objetivos de este son: 1. Evaluar el consumo de medicamentos, así como la automedicación entre los individuos que acuden a realizarse una endodoncia. 2.Evaluar la mejoría de sintomatología tras la toma de medicación. 3. Evaluar la ansiedad dental entre los pacientes sometidos a tratamiento endodóntico previo a la intervención. Material y Métodos: Se realizó un estudio de tipo observacional, transversal y comparativo, consistente en una encuesta sobre pacientes mayores de 16 años que acudieron a una clínica universitaria odontológica. Resultados: Se recopilaron 167 encuestas entre septiembre de 2017 y marzo del 2018, siendo válidas 131 y no válidas 36, cuyos resultados más destacados fueron los siguientes: · Ingesta de antibióticos + analgésicos y/o AINES (40,6%)· Ingesta analgésicos y/o AINES (59,4%). Origen de esa medicación; 44,6% prescrita por el odontólogo, seguida del 42,7% que corresponde a la tomada por decisión propia, 10,8% al médico de cabecera, 2,7% a urgencias y 0% al farmacéutico y de origen homeopático. Media de ansiedad en la escala de 4,38. La media de ansiedad en mujeres: 5 y en hombres: 3,2 (p: 0.0066). Grupo con algún tipo de formación académica; media de ansiedad: 4,24 y grupo sin ningún estudio; media de ansiedad: 8,75 (p: 0.0144). Conclusiones: Los pacientes encuestados tenían una alta tendencia a la automedicación, utilizándose fundamentalmente analgésicos y/o AINES. Además, referían mejoría en el día de la intervención tras haber tomado algún tipo de medicamento. Los pacientes encuestados sufrieron un grado de ansiedad medio previo a la realización del tratamiento endodóntico

Objectives: The objectives of this study are: 1. To evaluate the consumption of medicines as well as self-medication among the individuals who undergo endodontics.2. To evaluate the improvement of symptoms after taking medication. 3. To evaluate dental anxiety among patients undergoing endodontic treatment prior to the intervention. Material and Methods: An observational, transversal and comparative study was carried out, consisting of a survey of patients over 16 years of age who attended a university dental clinic. Results: In this study 167 surveys were collected, between September 2017 and March 2018, with 131 valid and 36 invalid. Taking antibiotics + analgesics and/or NSAIDs (40.6%) and analgesics and/or NSAIDs (59.4%); Origin of that medication; 44.6% prescribed by the dentist, followed by the 42.7% prescribed by the dentist, 10.8% by the general practitioner, 2.7% by the emergency department and 0% by the pharmacist and homeopathic origin. Average anxiety on the 4.38 scale. Average anxiety in women: 5 and in men: 3.2 (p: 0.0066).Group with some type of academic training; mean anxiety: 4.24 and group without any study; mean anxiety: 8.75 (p: 0.0144). Conclusions: The patients surveyed had a high tendency to self-medication, mainly using analgesics and/or NSAIDs. They also reported improvement on the day of the intervention after having taken some type of medication. The patients surveyed suffered a medium degree of anxiety prior to the endodontic treatment

Correlación entre estudios electrocardiográficos y cinecoronariográficos en enfermedades coronarias / Connection between electrocardiographic and cinecoronariographic studies in coronary diseases

Las enfermedades cardiovasculares son la principal causa de muerte en Chile. Los Síndromes Coronarios Agudos (SCA), obligan a los sistemas de salud a destinar recursos de elevado costo para su diagnóstico. Procedimientos como el electrocardiograma (ECG) y la cinecoronariografía (CCG) orientan en el diagnóstico de dichas patologías, siendo el ECG un examen no invasivo de fácil ejecución y de bajo costo. El objetivo de este estudio fue relacionar el examen ECG con la CCG para mejorar la precisión diagnóstica de obstrucción coronaria. El estudio fue de tipo descriptivo de corte transversal, constituido por 44 pacientes adultos de ambos sexos que presentaron infarto de miocardio con elevación de segmento ST (STEMI), derivados al Servicio de Hemodinamia de la Clínica Iquique, Chile, para intervención coronaria. Los 44 pacientes tenían un ECG previo y se les realizó una CCG. Los resultados establecieron una fuerte correlación entre los diagnósticos por ECG y por CCG del total de las arterias obstruidas (según prueba de Correlación de Pearson = 0,80; p < 0,001). Se demostró relación entre ambos exámenes en un 92,3 % (p = 0,001) para la obstrucción de la arteria coronaria derecha (ACD) con hallazgo electrocardiográfico que correspondía a infarto de pared inferior. Relación de 100 % para la obstrucción de la rama circunfleja de la arteria coronaria izquierda (ACI) (p = 0,036) y 100 % para la obstrucción de la rama interventricular anterior de la ACI o arteria coronaria descendente anterior (p = 0,001) correspondiente a infarto de pared lateral. Se concluyó que existe relación significativa entre el infarto de pared anterior según los hallazgos electrocardiográficos y la obstrucción de la ACD y la rama circunfleja de la ACI según CCG; además, la relación es significativa entre los infartos de pared lateral y pared anterior con hallazgos por ECG y la obstrucción de la rama interventricular anterior de la arteria coronaria izquierda diagnosticada por CCG. Es fundamental la interpretación correcta del ECG para mejorar la atención del infarto agudo al miocardio.

Cardiovascular diseases are the leading cause of death in Chile. Acute Coronary Syndrome (ACS) forces health systems to allocate high-cost resources for diagnosis. Procedures like Electrocardiogram (ECG) and cinecoronariography (CCG) guide the diagnosis of these pathologies, with ECG being a noninvasive exam easy to perform and of low cost. The aim of this study was to connect ECG exams with CCG to improve the diagnostic accuracy of coronary obstruction. This was a descriptive cross-sectional study, consisting of 44 adult patients of both sexes which presented myocardial infarction with ST-segment elevation (STEMI) referred to the Hemodynamic Service from Iquique Clinic, Chile, for coronary operation. All 44 patients had previous ECG and they were conducted a CCG. Results established a strong correlation between ECG and CCG diagnosis from the total of Clogged Arteries (according to Pearson correlation test = 0.80; p < 0.001). The correlation demonstrated in both exams was 92.3 % (p = 0.001) for blockage in the right coronary artery (RCA) with electrocardiographic finding corresponding to inferior wall infarction. 100 % relationship for the obstruction of the circumflex branch of the left coronary artery (LCA) (p = 0.036) and 100 % for the obstruction of RCA anterior interventricular branch or anterior descending coronary artery (p = 0.001) corresponding to a lateral wall infarction. It is concluded that there is a significant relationship between anterior wall infarction according to electrocardiographic findings and RCA obstruction and LCA circumflex branch according to CCG. In addition, there is a significant relationship between lateral wall infarction and interior walls by ECG findings and the obstruction of the anterior interventricular branch of the left coronary artery diagnosed by CCG. The correct interpretation of ECG is essential to improve the care of acute myocardial infarction.

Asociación entre la higiene oral y la prevalencia de caries dental en escolares de 6 a 12 años de edad de la institución educativa San Gabriel, Villa María del Triunfo, en 2017 / Association between oral hygiene and the prevalence of dental caries in schoolchildren from 6 to 12 years of age at the San Gabriel Educational Institution, in the Villa Maria del Triunfo district of Lima, in 2017

Objetivo: Determinar la asociación entre la prevalencia de caries dental y el índice de higiene oral simplificado Green Vermillion en escolares de 6 a 12 años de una IE del distrito de Villa María del Triunfo. Materiales y métodos: Se ejecutó un estudio de tipo descriptivo, transversal y prospectivo con 129 niños de 6 a 12 años de una institución educativa San Gabriel, Villa María del Triunfo (Lima, Perú). Se usó el Índice de CPO-D para determinar la presencia de caries. Para la evaluación del índice de higiene oral, se empleó el índice de Green y Vermillion. Para el análisis estadístico, se aplicó el paquete estadístico SPSS versión 23. Esta etapa se comenzó con un análisis univariado que consistió en describir la frecuencia de caries dental por sexo y grupo etario. Seguidamente, se realizó un análisis bivariado que consistió en la prueba no paramétrica de Xi cuadrado para determinar la asociación de cada factor de riesgo. Resultados: Se determinó que la prevalencia de caries dental fue del 85,3% y se encontró una asociación estadísticamente significativa entre la prevalencia de caries dental y el índice de higiene oral Green Vermillion. Conclusiones: La higiene oral se encuentra relacionada de manera significativa con la prevalencia de caries dental. (AU)

Objective: To determine the relationship between the prevalence of dental caries and the Greene and Vermillion Simpli-fied Oral Hygiene Index in schoolchil-dren from 6 to 12 years of age in the Villa Maria del Triunfo district of Lima, Peru. Materials and methods: A descriptive, cross-sectional and prospective study was conducted among 129 children aged from 6 to 12 years, at the San Gabriel Educational Institution, in the Lima district of Villa Maria del Triunfo, in Peru. The CPO-D Index was used to determine the presence of caries. The oral hygiene index used was the Greene and Vermi-llion Simplified Oral Hygiene Index. The IBM SPSS 23.0 software package was employed for statistical analysis. The univariate analysis conducted consisted of describing the frequency of dental caries according to gender and age group. This was followed by a bivariate analysis, employing a non-parametric Chi-square test to determine the asso-ciation of each risk factor. Results: The prevalence of dental caries was 85.3% and there was a statistically significant association between the prevalence of dental caries and the Greene and Vermi-llion Oral Hygiene Index. Conclusions: Oral hygiene is significantly related to the prevalence of dental caries. (AU)

[Insulin autoimmune syndrome: Report of two cases]. / Síndrome de hipoglicemia autoinmune: Primeros casos en Chile.

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia with extremely high insulin levels and the presence of circulating autoantibodies against insulin, in patients who have never been exposed to exogenous insulin. We report two patients with the syndrome. A 36 years old male presenting with hypoglycemia in the emergency room had an oral glucose tolerance test showed basal and 120 min glucose levels of 88 and 185 mg/dl. The basal and 120 min insulin levels were 2,759 and 5,942 µUI/ml. The presence of an insulin secreting tumor was discarded. Anti-insulin antibodies were positive. He was successfully treated with a diet restricted in carbohydrates and frequent meals in small quantities. A 65 years old female presenting with hypoglycemia in the emergency room had the fasting insulin levels of 1,910 µUI/ml. No insulin secreting tumor was detected by images and anti-insulin antibodies were positive. The polyethylene glycol precipitation test showed a basal and after exposition insulin level 1,483 and 114 µUI/ml, respectively. She responded partially to diet and acarbose and required the use of prednisone with a good clinical response.

Síndrome de hipoglicemia autoinmune: Primeros casos en Chile / Insulin autoimmune syndrome: Report of two cases

Insulin autoimmune syndrome (IAS) is characterized by spontaneous hypoglycemia with extremely high insulin levels and the presence of circulating autoantibodies against insulin, in patients who have never been exposed to exogenous insulin. We report two patients with the syndrome. A 36 years old male presenting with hypoglycemia in the emergency room had an oral glucose tolerance test showed basal and 120 min glucose levels of 88 and 185 mg/dl. The basal and 120 min insulin levels were 2,759 and 5,942 μUI/ml. The presence of an insulin secreting tumor was discarded. Anti-insulin antibodies were positive. He was successfully treated with a diet restricted in carbohydrates and frequent meals in small quantities. A 65 years old female presenting with hypoglycemia in the emergency room had the fasting insulin levels of 1,910 µUI/ml. No insulin secreting tumor was detected by images and anti-insulin antibodies were positive. The polyethylene glycol precipitation test showed a basal and after exposition insulin level 1,483 and 114 µUI/ml, respectively. She responded partially to diet and acarbose and required the use of prednisone with a good clinical response.

La biotecnología como herramienta para la propagación, conservación y el mejoramiento genético del guayabo / Biotechnology as a tool for propagation, con-servation and genetic breeding in guava

Las técnicas biotecnológicas contribuyen positiva y significativamente en los programas de propagación, conservación y mejoramiento de las especies vegetales. Dentro de éstas, el cultivo de tejidos, el desarrollo de mapas de ligamientos genéticos y de QTLs y la detección de genes de interés han demostrado ser de gran utilidad para los mencionados propósitos. En este sentido, se estandarizó una técnica para la multiplicación in vitro de la forma silvestre de guayabo en tres fases de cultivo: establecimiento, multiplicación de propágulos y enraizamiento. La misma constituye una vía de utilidad para la propagación, la conservación de germoplasma y el mejoramiento genético en la especie. Además, se estandarizó un método de conservación a corto-mediano plazo. Por otra parte, se construyó un mapa de ligamiento genético para la especie empleando marcadores AFLP y SSR. Los 11 grupos del mapa de ligamiento genético y los 50 QTLs relacionados con caracteres vegetativos y de calidad interna y externa del fruto, constituyen el punto de partida para el clonaje de genes de interés agrícola y la implementación futura de la selección asistida por marcadores en el guayabo. De igual forma, las 176 secuencias candidatas a genes de resistencia (RGL) y del desarrollo de la planta (MADS-box y HOMEO-box) detectadas pueden ser de gran utilidad en la saturación del mapa de ligamiento referido, el estudio de la variabilidad presente en el cultivo, así como en la solución de problemas relacionados con el rendimiento, la producción y la resistencia a estrés biótico y abiótico

Biotechnologies contribute positively and signifi¬cantly in the propagation, conservation and breeding programs of many plant species. From them, tissue culture, linkage maps and QTLs detection for interesting genes have been proved to be of great utility for these purposes. In this sense, a technique for in vitro multiplication of wild guava was standardized in three culture phases: establishment, multiplication and rooting. This technique constituted a useful way for propagation, germplasm conservation and genetic breeding in the specie. A method for short-medium term conservation was also standardized. On the other hand, a genetic linkage map was constructed for the specie using AFLP and SSR markers. The 11 groups of the genetic linkage map and the 50 QTLs related with vegetative and internal/external fruit characters constitute the starting point for genes cloning of agricultural interest and the future imple¬mentation of markers assisted selection in guava. Also, the 176 candidate sequences for resistance-gene-like (RGL) and plant development (MADS-box and HOMEO-box) genes detected can be of great utility in linkage map saturation, variability studies in this crop, as well as in the solution of problems rela¬ted with yielding and resistance to biotic and abiotic stresses.

Implicaciones médicas y legales de la certificación de "nacido vivo" en Colombia / Medical and legal implications of a “life birth” certificate in Colombia

En Colombia se han dado pasos importantes en el abordaje y manejo de los fetos, embriones y recién nacidos fallecidos, no obstante se requiere mayor difusión de las normas y conceptos existentes, además de implementar algunas medidas faltantes. Es necesario hacer claridad sobre los conceptos ya que las implicaciones legales de la certificación de un niño(a) nacido(a) vivo(a), son muy significativas para los pacientes, las familias, las instituciones y la sociedad. El objetivo del presente documento es hacer una reflexión de los aspectos médicos y legales relevantes acerca del tema.

Important steps have been made in Colombia regarding the approach to and handling of fetuses, embryos and the newborn born dead; however, there is still a need for making existing standards and concepts more widely known and implementing those which are lacking. Greater clarity is needed concerning the pertinent concepts since the legal implications of certifying a child born alive are very significant for patients, families, institutions and society. The present document was aimed at reflecting on the relevant medical and legal aspects concerning the topic.

[Chilean results of the international registry of risk factors and treatment of unstable angina and non ST elevation myocardial infarction: ACCORD (ACute CORonary syndrome Descriptive study)]. / Resultados Chilenos del registro internacional de factores de riesgo y tratamiento de angina inestable e infarto al miocardio sin supradesnivel del segmento ST: ACCORD (ACute CORonary syndrome Descriptive study).

BACKGROUND: Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however, current practices are unknown in Chile. AIM: To evaluate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors. MATERIAL AND METHODS: One year prospective International non interventional registry, conducted in Chile between January 2005 and November 2006. RESULTS: Two hundred thirty three Chilean NSTEMI patients were enrolled. Mortality was 5.5% at the end of the follow-up. Mean age was 61.6 years, and 30.6% were female. Most of the patients had at least one risk factor (98%): hypertension (84%), previous myocardial infarction (33%), dyslipidemia (54%), diabetes (33%), current smoking (30%). Main procedures during the hospitalization were coronary angiogram (67%), angioplasty (33%; 88% with stent) and coronary bypass surgery (7%). During procedures, 31% of patients received clopidogrel, and 4.2% glycoprotein Ilb/IIIa antagonists. Medical management was selected for 60% of patients. In comparison to men, women received less interventional procedures despite having more risk factors. Treatments prescribed at discharge were aspirin (97%), clopidogrel (49%), beta blockers (78%), diuretics (21%), lipid lowering agents (78%), oral hypoglycemic agents (13%) and insulin (9%). At the end of the 1-year follow-up, treatments were aspirin (84%), beta blockers (72%), diuretics (19%), and dual antiplatelet therapy with clopidogrel (16%). CONCLUSIONS: A high prevalence of multiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50% at discharge and decreases during the one year-follow-up.

Resultados Chilenos del registro internacional de factores de riesgo y tratamiento de angina inestable e infarto al miocardio sin supradesnivel del segmento ST: ACCORD (ACute CORonary syndrome Descriptive study) / Chilean results of the international registry of risk factors and treatment of unstable angina and non ST elevation myocardial infarction: ACCORD (ACute CORonary syndrome Descriptive study)

Background: Guidelines for the management of unstable angina (UA) and non ST elevation myocardial infarction (NSTEMI) have been issued, however cu-rrent practices are unknown in Chile. Aitn: To evalúate in a prospective cohort of NSTEMI patients the current practices, treatments and risk factors. Material and Methods: Oneyear prospective International non interventional registry, conducted in Chile between January 2005 and November 2006. Results: Two hundred thirty three Chilean NSTEMI patients were enrolled. Mortality was 5.5 percent at the end ofthe follow-up. Mean age was 61.6 years, and 30.6 percent were female. Most of the patients had at least one risk factor (98 percent): hypertension (84 percent), previous myocardial infarction (33 percent), dyslipidemia (54 percent), diabetes (33 percent), current smoking (30 percent). Main procedures duringthe hospitalization were coronary angiogram (67 percent), angioplasty (33 percent; 88 percent with stent) and coronary bypass surgery (7 percent). Duringprocedures, 31 percent of patients received clopidogrel, and 4.2 percent glycoprotein Ilb/IIIa antagonists. Medical management was selected for 60 percent of patients. In comparison to men, women received less interventional procedures despite havingmore risk factors. Treatments prescribed at discharge were aspirin (97 percent), clopidogrel (49 percent), beta blockers (78 percent), diuretics (21 percent), lipid lowering agents (78 percent), oral hypoglycemic agents (13 percent) and insulin (9 percent). At the end ofthe 1-year follow-up, treatments were aspirin (84 percent), beta blockers (72 percent), diuretics (19 percent), and dual antiplatelet therapy with clopidogrel (16 percent). Conclusions: A high prevalence of múltiple risk factors for cardiovascular disease in Chilean patients with NSTEMI was observed. More aggressive primary and secondary preventive measures are urgently needed. Use of therapies proposed in the guidelines is high, but dual antiplatelet therapy is less than 50 percent at discharge and decreases during the one year-follow-up.

[Selective intra arterial calcium stimulation for the localization of insulinomas. Report of two cases]. / Test de estimulación intraarterial selectiva con calcio en el diagnóstico de localización de insulinomas. Casos clínicos.

Insulinoma is the most common neuroendocrine tumor. Its clinical manifestations are frequently confounded with neuropsychiatric symptoms, and definitive diagnosis can be delayed for a long time. These tumors are usually small, of less than 2 cm. Thus, their preoperative localization is difficult. We report two patients with a clinical diagnosis of insulinoma, in whom the preoperative imaging study was negative. Both fulfilled diagnostic criteria, with high serum insulin levels in the presence of a blood glucose of less than 45 mg/dl. The imaging study, including abdominal computed tomography and pancreatic endoscopic ultrasonogrphy did not disclose the location of the tumor. A pancreatic angiography with selective stimulation with intra arterial calcium and venous sampling for insulin measurements, was performed in both patients. This test allowed the exact localization of the tumors and their successful excision. A review of other localization diagnostic tests is done.

Hemodinamia arterial periférica no invasiva en la hipertensión arterial / Peripheral arterial hemodynamics in hypertensive patients

La introducción de la ecocardiografía bidimensional y el Doppler ha permitido su aplicación simultánea al estudio de la hemodinamia arterial periférica, por lo que se ha diseñado un estudio en arteria braquial en hipertensos no tratados para establecer sus características hemodinámicas en comparación a un grupo normal de control. En 76 hipertensos, edad promedio 60 ñ 12 años; PA promedio = 176/105 mmHg y en 57 normales, PA promedio 118/73 mmHg, con distribución por edad y sexo comparables, se midió diámetro y velocidad de flujo arteriales y se calcularon volumen sanguíneo local, resistencia vascular y distensibilidad arterial. Se comprobó que para similar sexo y edad, los hipertensos tienen significativamente mayor diámetro arterial y menor velocidad de flujo que los normales, y que los hipertensos jóvenes presentan precozmente aumento importante del diámetro, con aumento de la resistencia vascular y disminución de la distensibilidad. A mayor PA sistólica correspondió mayor diámetro arterial (r = 0,50) tanto en normales como hipertensos. La velocidad de flujo, que depende del tono de las arterias, tuvo en cambio "r" límite significativo con la PA diastólica (r = 0,44) para el total de normales e hipertensos. Se concluye que esta técnica aporta datos hemodinámicos significativos para el diagnóstico precoz del hipertenso al revelar un aumento importante del diámetro arterial y de la resistencia vascular y una disminución de la distensibilidad arterial