Caracterización y riesgo de fractura en población adulta chilena. Una nueva mirada a la ENS 2009-2010 / Characterization and risk of fracture in Chile's adult population. A new look at ENS 2009-2010

Resumen: Introducción: Las fracturas son lesiones relevantes en la vida de los individuos tanto por el costo del tratamiento, como por la carga en la vida laboral. La información en nuestro país acerca de esta patología es escasa, por lo que nos propusimos revisar datos epidemiológicos disponibles en la Encuesta Nacional de Salud (ENS). Material y métodos: Se calculó la prevalencia de vida de fracturas para la totalidad de la muestra y para los adultos mayores de 55 años, estimándose modelos de regresión logísticos distintos por sexo para la probabilidad de sufrir una fractura en la vida. Resultados: La prevalencia de vida de fracturas es de 18%, con 25.1% para los adultos mayores de 55 años, observándose mayor prevalencia en hombres que en mujeres (22.5 y 13.8% respectivamente). En el sexo masculino se asoció con fracturas: edad, tabaquismo, actividad física, consumo de alcohol e IMC, mientras que en el sexo femenino se asoció: edad, polifarmacia, estado civil y actividad física. Conclusión: Se encontró asociación entre la ocurrencia de fracturas y múltiples factores de riesgo conocidos para enfermedades crónicas, destacando la relevancia que poseen las fracturas en la población. Nueva evidencia orientada a estudiar este fenómeno se hace imperativa dado el envejecimiento progresivo de la población chilena.

Abstract: Introduction: Fractures are relevant injuries in the lives of individuals both for the cost of treatment and for the burden on working life. The information in our country about this pathology is scarce, so we set out to review epidemiological data available in the national health survey. Material and methods: The prevalence of fracture life was calculated for the entire sample and for adults over 55 years of age, with different logistic regression models estimated by sex for the likelihood of a fracture in life. Results: The prevalence of fracture life is 18%, with 25.1% for adults over 55 years of age, with higher prevalence observed in men than in women (22.5% and 13.8% respectively). In the male sex it was associated with fractures: age, smoking, physical activity, alcohol consumption, and BMI, while in the female sex it was associated: age, polypharmacy, marital status, and physical activity. Conclusion: An association was found between the occurrence of fractures and multiple known risk factors for chronic diseases, highlighting the relevance of fractures in the population. New evidence aimed at studying this phenomenon becomes imperative given the progressive ageing of the Chilean population.

[Characterization and risk of fracture in Chile's adult population. A new look at ENS 2009-2010]. / Caracterización y riesgo de fractura en población adulta chilena. Una nueva mirada a la ENS 2009-2010.

INTRODUCTION: Fractures are relevant injuries in the lives of individuals both for the cost of treatment and for the burden on working life. The information in our country about this pathology is scarce, so we set out to review epidemiological data available in the national health survey. MATERIAL AND METHODS: The prevalence of fracture life was calculated for the entire sample and for adults over 55 years of age, with different logistic regression models estimated by sex for the likelihood of a fracture in life. RESULTS: The prevalence of fracture life is 18%, with 25.1% for adults over 55 years of age, with higher prevalence observed in men than in women (22.5% and 13.8% respectively). In the male sex it was associated with fractures: age, smoking, physical activity, alcohol consumption, and BMI, while in the female sex it was associated: age, polypharmacy, marital status, and physical activity. CONCLUSION: An association was found between the occurrence of fractures and multiple known risk factors for chronic diseases, highlighting the relevance of fractures in the population. New evidence aimed at studying this phenomenon becomes imperative given the progressive ageing of the Chilean population.

INTRODUCCIÓN: Las fracturas son lesiones relevantes en la vida de los individuos tanto por el costo del tratamiento, como por la carga en la vida laboral. La información en nuestro país acerca de esta patología es escasa, por lo que nos propusimos revisar datos epidemiológicos disponibles en la Encuesta Nacional de Salud (ENS). MATERIAL Y MÉTODOS: Se calculó la prevalencia de vida de fracturas para la totalidad de la muestra y para los adultos mayores de 55 años, estimándose modelos de regresión logísticos distintos por sexo para la probabilidad de sufrir una fractura en la vida. RESULTADOS: La prevalencia de vida de fracturas es de 18%, con 25.1% para los adultos mayores de 55 años, observándose mayor prevalencia en hombres que en mujeres (22.5 y 13.8% respectivamente). En el sexo masculino se asoció con fracturas: edad, tabaquismo, actividad física, consumo de alcohol e IMC, mientras que en el sexo femenino se asoció: edad, polifarmacia, estado civil y actividad física. CONCLUSIÓN: Se encontró asociación entre la ocurrencia de fracturas y múltiples factores de riesgo conocidos para enfermedades crónicas, destacando la relevancia que poseen las fracturas en la población. Nueva evidencia orientada a estudiar este fenómeno se hace imperativa dado el envejecimiento progresivo de la población chilena.

Isolation on a remote island: genetic and morphological differentiation of a cosmopolitan odonate.

Although low levels of genetic structure are expected in highly widespread species, geographical and/or ecological factors can limit species distributions and promote population structure and morphological differentiation. In order to determine the effects of geographical isolation on population genetic structure and wing morphology, 281 individuals of the cosmopolitan odonate Pantala flavescens were collected from four continental (Central and South America) and five insular sites (Polynesian islands and the Maldives). COI sequences and eight microsatellite loci were used to characterize genetic diversity and genetic structure between and within locations. Linear and geometric morphometry were used to evaluate differences in the size and shape of wings. Genetic analysis showed a global genetic difference between the continental and insular sites. American locations did not show genetic structure, even in locations separated by a distance of 5000 km. Easter Island showed the lowest values of genetic diversity (mainly mitochondrial diversity) and the highest values of genetic differences compared to other insular and continental sites. Individuals from Easter Island showed smaller forewings, a different abdomen length to thorax length ratio, and a different configuration of anal loop in the hindwings. Thus, the greater isolation, smaller area, and young geological age seem to have determined the genetic and morphological differences in P. flavescens of Easter Island, where selection could promote a loss of migratory behavior and may improve other life history traits, such as reproduction. This work provides new insight into how microevolutionary processes operate in isolated populations of cosmopolitan species.

Alterations in chromosomal synapses and DNA repair in apoptotic spermatocytes of Mus m. domesticus.

We investigated whether apoptotic spermatocytes from the mouse Mus m. domesticus presented alterations in chromosomal synapses and DNA repair. To enrich for apoptotic spermatocytes, the scrotum's temperature was raised by partially exposing animals for 15 min to a 42ºC water bath. Spermatocytes in initial apoptosis were identified in situ by detecting activated Caspase-9.  SYCP1 and SYCP3 were markers for evaluating synapses or the structure of synaptonemal complexes and Rad51 and γH2AX for detecting DNA repair and chromatin remodeling. Apoptotic spermatocytes were concentrated in spermatogenic cycle stages III-IV (50.3%), XI-XII (44.1%) and IX-X (4.2%). Among apoptotic spermatocytes, 48% were in middle pachytene, 44% in metaphase and 6% in diplotene. Moreover, apoptotic spermatocytes showed several structural anomalies in autosomal bivalents, including splitting of chromosomal axes and partial asynapses between homologous chromosomes. gH2AX and Rad51 were atypically distributed during pachytene and as late as diplotene and associated with asynaptic chromatin, single chromosome axes or discontinuous chromosome axes. Among apoptotic spermatocytes at pachytene, 70% showed changes in the structure of synapses, 67% showed changes in gH2AX and Rad51 distribution and 50% shared alterations in both synapses and DNA repair. Our results showed that apoptotic spermatocytes from Mus m. domesticus contain a high frequency of alterations in chromosomal synapses and in the recruitment and distribution of DNA repair proteins. Together, these observations suggest that these alterations may have been detected by meiotic checkpoints triggering apoptosis.

Resultados a largo plazo de lasik para ametropía residual en queraplastia penetrante en pacientes con queratocono / Long-term results of lasik refractive error correction after penetrating keratoplasty in patients with keratoconus

OBJETIVO: Evaluar la efectividad a largo plazo del Lasik en la corrección de ametropías residuales a la queratoplastia (QP) en pacientes con queratocono (QC). DISEÑO: Cohorte retrospectiva. MÉTODOS: Análisis retrospectivo de fichas clínicas de 19 ojos (14 pacientes) operados de Lasik post-QP por QC. En todos los ojos, con estabilidad refractiva y remoción de suturas previas al Lasik, se evaluaron y compararon los siguientes resultados pre- y post-Lasik, de antes de un año de seguimiento y después de un año de seguimiento: agudeza visual corregida (AVCC) y sin corrección (AVSC), equivalente esférico (EE), astigmatismo refractivo (Ast.) y queratométrico (dK). Los datos fueron analizados con test de normalidad Shapiro-Wilk, t de Student y Mann-Whitney para grupos independientes. Se consideró significativo un valor p < 0,05. RESULTADOS: Tiempo promedio de seguimiento post-Lasik fue de 3,16 meses (DE 3,8) para grupo antes de un año de seguimiento y 5,8 años (DE 2,4) para grupo después de un año de seguimiento. La AVCC 0,11 LogMAR (DE 0,07) pre Lasik, se mantuvo estable en ambos grupos, mientras que el EE disminuyó de − 2,6 (DE 3,53) pre Lasik a −0,36 D (1,33) (p < 0,05) en el grupo antes de un año de seguimiento y a −1,28 D (DE 1,63) (p = 0,07) en el grupo después de un año de seguimiento. El Ast. bajó de −3,43 (DE 1,35) a −1,37 D (DE 1,24) (p < 0,05) a corto plazo antes del año, para aumentar a −3,21 D (DE 2,29) (p = 0,36) después del año postoperatorio. CONCLUSIÓN: Los resultados refractivos del Lasik desaparecen después del año, por lo tanto no es una cirugía refractiva efectiva a largo plazo para corregir los ER residuales en QP después del QC

OBJECTIVE: To evaluate the long term results of Lasik for residual refractive errors (RE) after penetrating keratoplasty (PKP) for keratoconus (KC). DESIGN: Retrospective cohort. METHOD: Records of 14 consecutive patients (19 eyes) who had Lasik after PKP for KC were retrospectively reviewed. In all eyes with refractive stability and suture removed before Lasik, far distance Visual Acuity with (AVCC) and without correction (AVSC), spherical equivalent (EE), refractive (Ast) and keratometric (dK) astigmatism were analyzed pre- and post-operatively before and after one year of follow up. Data were analyzed using Shapiro-Wilk normality test, Student t test and Mann-Whitney test. A P-value of <0,05 was considered statistically significant. RESULTS: The mean follow-up time was 3.16 months for the follow-up before one year postoperative and 5.8 years for the follow-up after one year postoperative. The best spectacle corrected visual acuity of 0,11 LogMAR (DE 0,07) before Lasik remained stable throughout the study. The SE decreased from −2.6 (DE 3.53) to −0,36 D (DE 1.33) (P<.05) for the follow-up before one year postoperative and −1.28 D (DE 1.63) (P=.07) for the follow-up after one year postop. The refractive cylinder was reduced from −3.43 (DE 1.35) preoperative to −1.37 D (DE 1.24) (P<.05) and −3.21 D (DE 2.29) (P=.36) in the long term after one year of follow-up. CONCLUSIONS: Lasik refractive results regress one year after the operation; therefore it is not an effective long-term surgical refractive procedure for residual refractive errors after PKP for KC

Estudio comparativo en queratoplastia para queratocono entre las técnicas lamelar profunda de Anwar (big bubble) y penetrante procedente de conversión / Comparative study of keratoconus between Anwar's deep anterior lamellar keratoplasty versus converted penetrating keratoplasty

OBJETIVO: El propósito de este grupo de estudio fue comparar los resultados entre los procedimientos de queratoplastia lamelar profunda anterior (deep anterior lamellar keratoplasty [DALK]) y queratoplastia penetrante (penetrating keratoplasty [PK]) en pacientes con queratocono. DISEÑO: Estudio de cohorte retrospectivo. MÉTODO: Se analizaron los resultados de 90 DALK y 49 PK procedentes de reconversión en pacientes con queratocono. Todos los procedimientos fueron realizados por el mismo cirujano (R.D.) desde 2006 hasta 2011. Entre ambos grupos se comparó la agudeza visual a distancia corregida (AVCC), el astigmatismo, el tiempo de la primera refracción, la paquimetría, el recuento de células endoteliales y las complicaciones postoperatorias. RESULTADOS: La media de edad fue de 28,2 años para DALK y de 31,7 años para PK (p = 0,17). El seguimiento medio fue de 14,7 meses para DALK y 19,4 meses para PK (p = 0,13). No hubo diferencia significativa alguna entre los grupos de PK y DALK en la media postoperatoria de AVCC (LogMAR) (0,17 frente a 0,17; p = 0,59), astigmatismo refractivo (-3,19 frente a -3,01 dioptrías; p = 0,65) ni en el tiempo de la primera refracción subjetiva (60,5 frente a 68 días; p = 0,50). Las principales complicaciones postoperatorias fueron 8% de rechazo endotelial en el grupo PK y 10% de vascularización de la interfaz en el grupo DALK. CONCLUSIONES: La única diferencia entre ambos grupos fue la neovascularización estromal profunda en DALK y el rechazo endotelial en PK, por lo que el procedimiento DALK debe ser considerado como primera opción en el tratamiento de pacientes con queratocono

OBJECTIVE: To compare outcomes between penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. DESIGN: Retrospective cohort study. METHODS: Data of 90 DALK and 49 procedures from conversion to PK, performed by a single surgeon (R.D.) from 2006 to 2011 were analysed. Outcomes on corrected distance visual acuity (BCVA), astigmatism, time to first refraction, pachymetry, endothelial count cell, and postoperative complications were compared between these groups. RESULTS: The mean age of the patients who underwent DALK and PK was 28.2 and 31.7 years, respectively (P=.17). The mean follow up for DALK and for the PK group was 14.7 and 19.4 months, respectively (P=.13). There was no significant difference between PK and DALK groups in the mean postoperative for: BCVA (LogMAR) (0.17 vs. 0.17; P=.59); refractive astigmatism (-3.19 vs.-3.01 diopters; P=.65), and time for the first subjective refraction (60.5 versus 68 days; P=.50). Main postoperative complications were 8% of endothelial rejection in PK group and 10% of deep stromal vascularization in DALK group. CONCLUSIONS: The only differences in postoperative results between groups were stromal neovascularization in DALK group and endothelial rejection in PK group. DALK should be considered as the first option when keratoplasty is indicated in keratoconus

[Long-term results of lasik refractive error correction after penetrating keratoplasty in patients with keratoconus]. / Resultados a largo plazo de lasik para ametropía residual en queraplastia penetrante en pacientes con queratocono.

OBJECTIVE: To evaluate the long term results of Lasik for residual refractive errors (RE) after penetrating keratoplasty (PKP) for keratoconus (KC). DESIGN: Retrospective cohort. METHOD: Records of 14 consecutive patients (19 eyes) who had Lasik after PKP for KC were retrospectively reviewed. In all eyes with refractive stability and suture removed before Lasik, far distance Visual Acuity with (AVCC) and without correction (AVSC), spherical equivalent (EE), refractive (Ast) and keratometric (dK) astigmatism were analyzed pre- and post-operatively before and after one year of follow up. Data were analyzed using Shapiro-Wilk normality test, Student t test and Mann-Whitney test. A P-value of <0,05 was considered statistically significant. RESULTS: The mean follow-up time was 3.16 months for the follow-up before one year postoperative and 5.8 years for the follow-up after one year postoperative. The best spectacle corrected visual acuity of 0,11 LogMAR (DE 0,07) before Lasik remained stable throughout the study. The SE decreased from -2.6 (DE 3.53) to -0,36 D (DE 1.33) (P<.05) for the follow-up before one year postoperative and -1.28 D (DE 1.63) (P=.07) for the follow-up after one year postop. The refractive cylinder was reduced from -3.43 (DE 1.35) preoperative to -1.37 D (DE 1.24) (P<.05) and -3.21 D (DE 2.29) (P=.36) in the long term after one year of follow-up. CONCLUSIONS: Lasik refractive results regress one year after the operation; therefore it is not an effective long-term surgical refractive procedure for residual refractive errors after PKP for KC.

Comparative study of keratoconus between Anwar's deep anterior lamellar keratoplasty versus converted penetrating keratoplasty.

OBJECTIVE: To compare outcomes between penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. DESIGN: Retrospective cohort study. METHODS: Data of 90 DALK and 49 procedures from conversion to PK, performed by a single surgeon (R.D.) from 2006 to 2011 were analysed. Outcomes on corrected distance visual acuity (BCVA), astigmatism, time to first refraction, pachymetry, endothelial count cell, and postoperative complications were compared between these groups. RESULTS: The mean age of the patients who underwent DALK and PK was 28.2 and 31.7 years, respectively (P=.17). The mean follow up for DALK and for the PK group was 14.7 and 19.4 months, respectively (P=.13). There was no significant difference between PK and DALK groups in the mean postoperative for: BCVA (LogMAR) (0.17 vs. 0.17; P=.59); refractive astigmatism (-3.19 vs.-3.01 diopters; P=.65), and time for the first subjective refraction (60.5 versus 68 days; P=.50). Main postoperative complications were 8% of endothelial rejection in PK group and 10% of deep stromal vascularization in DALK group. CONCLUSIONS: The only differences in postoperative results between groups were stromal neovascularization in DALK group and endothelial rejection in PK group. DALK should be considered as the first option when keratoplasty is indicated in keratoconus.

Ab initio molecular dynamics study of small alkali metal clusters.

In this work, the dynamics of the clusters of the type M3 with M a metal alkaline atom from Li to Cs have been studied. Other heteroatomic mixed clusters like LiNaK and one bigger cluster, Na7, have also been studied. It was found that the dynamics present interesting phenomena like pseudorotations and crossovers which could explain the differences between experimental and theoretical values of some electrical properties, like the electric dipole moment of alkali metal clusters.

Indicadores de calidad en cáncer de mama / Quality indicators in breast cancer surgery

Introduction: although clear guidelines for breast cancer management have been developed and widespread, there are many variations between centers and even among breast cancer surgeons, with impact in clinical outcomes. Use of quality indicators to assess surgical care allows comparison with standards and with other centers and monitoring changes post intervention. Objective: to apply quality indicators to breast cancer surgery and evaluate usefulness. Material and Methods: selected indicators obtained from EUSOMA 2008 workshop were applied to 213 consecutive surgical treatment breast cancer patients from Hospital Militar de Santiago de Chile between 2006 and 2011, comparing results with previously defined standards. Results: benign/malignant index in surgical biopsies: 1: 2.27 (minimum standard: 1/2; Optimum: 1/4), patients with complete pathologic report percentage: 99,2 percent (minimum: 95 percent, optimum: 98 percent), breast conserving surgery percentage: 80.20 percent (minimum: 70 percent, optimum: 80 percent), patients with sufficient axillary sampling percentage: 92.4 percent (minimum: 95 percent, optimum: 98 percent), correct axillary dissection indication percentage: 100 percent (minimum: 95 percent, optimum: 98 percent) and patients who underwent single surgery percentage: 90.40 percent (minimum: 80 percent, optimum: 90 percent), most of them ranged between established standards. Conclusion: the use of quality indicators allows breast cancer surgery result evaluation, enabling comparison between centers and established standards, giving objective and reproducible information, helpful to plan process optimization. These or similar indicators are useful in all breast cancer treatment steps and for breast cancer unit accreditation processes. Our indicator values that are under the standard reveal that some specific local indicators are required.

Introducción: aunque existen guías clínicas ampliamente difundidas para el manejo del cáncer de mama, las variaciones entre centros impactan en los resultados. El uso de indicadores de calidad, permite compararse con estándares, con otros centros y evaluar los cambios posteriores a una intervención. Objetivos: aplicar indicadores de calidad al tratamiento quirúrgico del cáncer de mama evaluando su utilidad. Material y Métodos: se aplicó indicadores de calidad a 213 pacientes consecutivos sometidos a cirugía por cáncer de mama en el Hospital Militar de Santiago entre mayo/2006 y abril/2011, comparando los resultados con estándares. Resultados: se calculó: índice benignidad/malignidad en biopsias quirúrgicas: 1:2,27 (mínimo 1:2; óptimo 1:4), porcentaje pacientes con informe patológico completo 99,2 por ciento (mínimo: 95 por ciento, óptimo: 98 por ciento), porcentaje cirugía conservadora 68,42 por ciento (mínimo: 70 por ciento, óptimo: 80 por ciento), porcentaje pacientes con muestreo axilar suficiente 92,40 por ciento (mínimo: 95 por ciento, óptimo: 98 por ciento), porcentaje pacientes con indicación adecuada de disección axilar 100 por ciento y porcentaje pacientes que requirió una sola cirugía 90,40 por ciento (mínimo: 80 por ciento, óptimo: 90 por ciento). La mayoría cumplió los estándares establecidos. Conclusión: la utilización de indicadores de calidad permite evaluar resultados a través del tiempo, compararse con otros centros, y con los estándares establecidos. Proporciona información objetiva y reproducible que permite evidenciar los puntos críticos en los procesos y focalizarse en ellos. El uso de indicadores de calidad puede ampliarse a todas las etapas del tratamiento del cáncer de mama y servir para unificar criterios en acreditación. El análisis de los valores que resultaron bajo el estándar reveló la necesidad de proponer nuevos indicadores útiles a nivel local.

Asimetría en la función relativa en CR DMSA en riñones con doble sistema excretor no complicado: variante normal / Asymmetry in the relative function in CR DMSA in kidneys weith double non complicated excretor system: normal Variant

Introducción: El doble sistema excretor (DS) al Cintigrama Renal (CR) DMSA, con asimetría en la función relativa es un hallazgo relativamente frecuente. Evaluamos su incidencia, correlación con ecografía y valores de función relativa. Material y Método: Se seleccionaron los CR DMSA con diagnóstico cintigráfico de DS sin otras alteraciones. Ecografías sin otros hallazgos. Se comparó la función relativa entre riñones con y sin DS y entre riñones con y sin asimetría de tamaño. T-Test para muestras independientes. Se correlacionó el DMSA con la ecografía. Resultados: 79 pacientes en que se dispuso ecografía fueron estudiados. 17 con DS bilateral (21,5 por ciento). 72 por ciento mujeres, promedio de edad: 54,4 meses (1–204). Función relativa promedio en riñones con DS unilateral: 51,8 por ciento (43-61 por ciento) y 48,19 por ciento (39-57por ciento) en riñones sin DS. p<0,0001. En riñones con DS y aumentados de tamaño la diferencia con el contralateral fue mayor que en los de igual tamaño. Ecografía concordante con el CR DMSA en 52,63 por ciento. Conclusiones: 1.- La función relativa en riñones con Doble Sistema fue significativamente mayor que en riñones sin Doble Sistema, especialmente cuando existió asimetría en el tamaño renal. Esta condición debe considerarse variante normal para evitar la interpretación errada de riñones contralaterales hipofuncionantes. 2.- En la mitad de los pacientes hubo concordancia con la ecografía en diagnóstico de DS, hallazgo esperable.

Aim: Duplex system in DMSA with asymmetry in relative function it’s a frequent finding. We evaluated the incidence, correlation with sonography and the relative functions in these kidneys. Method: We selected patients with scintigraphic diagnosis of duplex system in the DMSA, without any other scintigraphic lesions and had a normal ultrasound. We compared the relative renal function in kidneys with and without duplex system and in kidney with and without size asymmetry. Independent samples t test was applied. DMSA results were compared with ultrasound. Results: 79 patients had ultrasound. 17 with bilateral DS (21.5 percent). 72 percent women; median age: 54.4 months (1–204). Relative function in unilateral DS kidney was 51.8 percent (43-61 percent) and 48.19 percent in kidneys without DS (39-57 percent), p< 0.0001. In kidneys larger and DS the difference in relative function with the contralateral kidney was more important than kidney with similar size. The ultrasound was concordant with DMSA in 52.63 percent of the patients. Conclusions: 1.- The relative function values were significantly higher in kidneys with Duplex System than kidneys without it, especially with asymmetry of the renal size .This condition should be consider a normal variant for to avoid the wrong interpretation of hipofunctioning contralateral kidney. 2.- Half of the patients had duplex system in DMSA scintigraphy and ultrasound, which was predictable.

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

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

Contrasting performances of generalist and specialist Myzus persicae (Hemiptera: Aphididae) reveal differential prevalence of maternal effects after host transfer.

Transgenerational maternal effects on performance (rm) after host transfer were evaluated in the generalist aphid Myzus persicae s.s., and in its subspecies specialized on tobacco, M. persicae nicotianae Blackman. We tested whether the performance of these taxa, when reared separately on optimal and suboptimal hosts (as sources of different maternal background) and then transferred to optimal hosts, experienced variations along four successive generations. Additionally, to compare the tolerance of both taxa to stress following host transfers, developmental instability (fluctuating asymmetry and body abnormalities) along the four generations was assessed. Taxon, rearing host, and generation affected the performance after host transfer. In the generalist, there was a significant improvement of rm along generations when transferred from suboptimal to optimal host and a significant decrease when transferred from optimal to optimal host; in the specialist, no increase or decrease occurred in any host transfer treatment. Transfer from suboptimal to optimal hosts caused higher losses of remaining replicates along generations than transfers from optimal to optimal hosts, and the specialist showed higher losses than the generalist. The only significant effect detected in comparisons involving fluctuating asymmetry values was that of taxon on length of siphunculi. Frequency of body abnormalities was not affected by treatments. Collectively, these results show a transgenerational weakening of maternal effects in the generalist but not in the specialist aphid, and suggest that rearing the latter in a suboptimal host causes not easily reversible changes that further give rise to constraints in performance.

[Renal scars after one year of follow up in children with a first episode of acute pyelonephritis]. / Cicatriz renal detectada mediante cintigrama renal DMSA en niños con primera pielonefritis aguda: estudio de factores de riesgo.

BACKGROUND: Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis. AIM: To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis. PATIENTS AND METHODS: Clinical records of children with a first episode of acute pyelonephritis that were assessed within seven days of the episode with RC DMSA were reviewed. Children were considered eligible if they did not have a new episode of acute pyelonephritis and a second RC DMSA, one year after the first episode, was performed. The presence or absence of a renal scar after one year was associated to demographic, scintigraphy and laboratory variables. RESULTS: Fifty nine children, aged 1 month to 10 years, 35 females, were studied. Thirty nine percent had a renal scar in the scintigraphy perfomed after one year of follow up. The presence of a scar was correlated with a C reactive protein over 130 mg/dl and an altered relative renal function (below 44%), during the acute phase. CONCLUSIONS: A high C reactive protein and alterations of relative renal function during the acute phase of acute pyelonephritis in children, may be risk factors for the development of renal scars in the long term follow up.

Cicatriz renal detectada mediante cintigrama renal DMSA en niños con primera pielonefritis aguda: estudio de factores de riesgo / Renal scars after one year of follow up in children with a first episode of acute pyelonephritis

Background: Acute pyelonephritis in children can leave a kidney scar that eventually can lead to hypertension or renal failure. 99mTc-dimercaptosuccinic acid renal scintigraphy (RC DMSA) is a widely accepted technique to assess children with acute pyelonephritis. Aim: To evaluate the presence of residual kidney scars detected through RC DMSA, in children with a first episode of acute pyelonephritis. Patients and methods: Clinical records of children with a first episode of acute pyelonephritis that were assessed within seven days of the episode with RC DMSA were reviewed. Children were considered eligible if they did not have a new episode of acute pyelonephritis and a second RC DMSA, one year after the first episode, was performed. The presence or absence of a renal scar after one year was associated to demographic, scintigraphy and laboratory variables. Results: Fifty nine children, aged 1 month to 10 years, 35 females, were studied. Thirty nine percent had a renal scar in the scintigraphy perfomed after one year of follow up. The presence of a scar was correlated with a C reactive protein over 130 mg/dl and an altered relative renal function (below 44%), during the acute phase. Conclusions: A high C reactive protein and alterations of relative renal function during the acute phase of acute pyelonephritis in children, may be risk factors for the development of renal scars in the long term follow up.

[Evaluation of refractive prognosis factors in myopic LASIK]. / Evaluación de factores pronósticos refractivos en LASIK miópico.

PURPOSE: Our objective was to evaluate myopic Lasik refractive results according to preoperative refraction findings. METHODS: In 200 eyes, classified into 4 groups according to preoperative sphere and cylinder findings, different postoperative refractive parameters were compared: predictability, visual acuity (VA), security index (SI) and efficacy index (EI). RESULTS: Grouped by sphere: spherical correction was better than cylindrical correction. Highest negative spheres resulted in undercorrection (p<0.0171). The residual astigmatism was similar and the predictability within +/- 1.0 D was lower for the most myopic groups. Grouped according to cylinder: the higher the cylinder, the more cylinder undercorrection (p<0.05) and more sphere overcorrection was achieved (p=0.0469). Between the lowest and highest cylinder levels, the residual astigmatism difference was of -0.32 x 90 degrees and predictability +/-1.0 D was of 98 and 94% for the sphere and 96 and 88% for the cylinder respectively. Defocus Equivalent <1 D for the lowest and highest myopic groups was 74 vs. 46% for the cylinder and 82 vs. 38% for the sphere respectively. Pre and postoperative VA were lower for higher spheres or cylinders. SI >1.0 was similar to EI (+/-0.9), for preoperative sphere and cylinder groups. Best corrected visual acuity (BCVA) of 20/25 by sphere was 100% vs. 60% and of 20/30 by cylinder was 100% vs. 83%, for lower and higher myopic groups respectively. CONCLUSIONS: Analysis by grouping preoperative refractive errors is helpful for establishing its influence and improving LASIK prognosis and treatment. This procedure is effective and safe for all groups, and its inaccuracy is due more to astigmatism than to spherical error. As astigmatism increases, less spherical and higher cylindrical ablation should be performed.

Evaluación de factores pronósticos refractivos en Lasik miópico / Evaluation of refractive prognosis factors in myopic Lasik

Introducción: Nuestro objetivo es evaluar los resultados refractivos de LASIK miópico, según refracción preoperatoria.Método: En 200 ojos, agrupados en 4 grupos por esfera y cilindro preoperatorio, se compraró distintos parámetros refractivos postoperatorios: predictibilidad, agudeza visual (AV) e índices de seguridad (IS) y eficacia (IE).Resultados: Ordenados por esfera: La esfera se corrige mejor que el cilindro, subcorrigiéndose las más miopes (p1,0 fue similar al IE (±0,9), por esfera y cilindro preoperatorio.La predictibilidad de AV con corrección 20/25 fue de 100% a 60% por esfera, y para 20/30 por cilindro de 100% a 83%, en los grupos menos y más miopes respectivamente.Conclusiones: El análisis por grupos de error refractivo preoperatorio permite determinar su influencia para mejorar el pronóstico y tratamiento Lasik. Es muy seguro y eficaz para todos los grupos, y su inexactitud depende fundamentalmente del astigmatismo y en menor grado de la esfera preoperatoria. A mayor astigmatismo se debe disminuir la ablación esférica y aumentar la cilíndrica

Purpose: Our objective was to evaluate myopic Lasik refractive results according to preoperative refraction findings.Methods: In 200 eyes, classified into 4 groups according to preoperative sphere and cylinder findings, different postoperative refractive parameters were compared: predictability, visual acuity (VA), security index (SI) and efficacy index (EI).Results: Grouped by sphere: spherical correction was better than cylindrical correction. Highest negative spheres resulted in undercorrection (p1.0 was similar to EI (±0.9), for preoperative sphere and cylinder groups.Best corrected visual acuity (BCVA) of 20/25 by sphere was 100% vs. 60% and of 20/30 by cylinder was 100% vs. 83%, for lower and higher myopic groups respectively.Conclusions: Analysis by grouping preoperative refractive errors is helpful for establishing its influence and improving LASIK prognosis and treatment. This procedure is effective and safe for all groups, and its inaccuracy is due more to astigmatism than to spherical error. As astigmatism increases, less spherical and higher cylindrical ablation should be performed

Host selection by the generalist aphid Myzus persicae (Hemiptera: Aphididae) and its subspecies specialized on tobacco, after being reared on the same host.

Decision-making during host selection by phytophagous insects has proved to be related to host range, with specialists taking faster decisions than generalists; however, this pattern fails to materialize in some host selection studies performed with aphids. Differences found in testing designs point to rearing effects on aphid host selection. To test whether specialization patterns derive from the nature of the aphid or as a consequence of rearing environment, host selection behaviours were compared between the generalist Myzus persicae (Sulzer) s.s. and its subspecies specialized on tobacco when reared on a common host and offered the choice of an alternative host and a non-host plant. Pre-alighting (host finding and attraction towards host volatiles) and post-alighting (leaf surface exploration and probing) behaviours did not differ between the generalist and the tobacco-specialist, except in the allocation of time to probing behaviour; furthermore, all specialists chose the host on which they performed best. Thus, although the specialist was not faster than the generalist, it showed a higher level of commitment to its preferred host plant.

Diet breadth and its relationship with genetic diversity and differentiation: the case of southern beech aphids (Hemiptera: Aphididae).

Herbivorous insect species with narrow diet breadth are expected to be more prone to genetic differentiation than insect species with a wider diet breadth. However, a generalist can behave as a local specialist if a single host-plant species is locally available, while a specialist can eventually behave as a generalist if its preferred host is not available. These problems can be addressed by comparing closely related species differing in diet breadth with overlapping distributions of insect and host populations. In this work, diet breadth, genetic diversity and population differentiation of congeneric aphid species from southern beech forests in Chile were compared. While at the species level no major differences in genetic diversity were found, a general trend towards higher genetic diversity as diet breadth increased was apparent. The aphid species with wider diet breadth, Neuquenaphis edwardsi (Laing), showed the highest genetic diversity, while the specialist Neuquenaphis staryi Quednau & Remaudière showed the lowest. These differences were less distinct when the comparisons were made in the same locality and over the same host. Comparison of allopatric populations indicates that genetic differentiation was higher for the specialists, Neuquenaphis similis Hille Ris Lambers and N. staryi, than for the generalist N. edwardsi. Over the same host at different locations, genetic differentiation among populations of N. edwardsi was higher than among populations of N. similis. The results support the assumption that specialists should show more pronounced genetic structuring than generalists, although the geographical distribution of host plants may be playing an important role.

Evaluación preliminar de una técnica para medir filtración glomerular, utilizando DTPA-Tc-99m en adultos y niños / Preliminary evaluation of a technique to measure glomerular filtration, using DTPA-Tc-99m on adults and children

El clearance de una sustancia se usa para expresar la capacidad que tienen los riñones de depurar el plasma. Si esta sustancia no es secretada, reabsorbida ni metabolizada por los túbulos renales y pasa libremente a travÚs de la membrana glomerular, puede ser utilizada como un buen indicador de la velocidad de filtración glomerular. El DTPA-Tc-99m es una molÚcula que cumple con estos requisitos y, por el hecho de ser un radioisótopo, nos permite además realizar la cintigrafía. El propósito de este trabajo fue implementar y evaluar en forma preliminar una tecnica de medición de velocidad de filtración glomerular utilizando DTPA-Tc-99m en el Servicio de Medicina Nuclear. Se estudiaron ocho pacientes, seis de ellos con algún tipo de patología renal y dos voluntarios sanos. El promedio de los clearance fue de 100,3 ml/min/1,73 m² y su DS = 61. En este estudio, se correlacionaron los antecedentes clínicos y exßmenes complementarios con el clearance de DTPA-Tc-99m y, posteriormente, se comparó si los resultados obtenidos con lo esperado por las patologías presentadas por los pacientes. En el trabajo se discuten las ventajas y desventajas del método, evaluando tanto su puesta en prßctica como su utilidad clínica. Se concluye que Ústa es una tÚcnica útil y de fßcil realización.