Síndrome de Cogan típico: a propósito de un caso / Typical Cogan’s syndrome: report of a case

Introducción: El síndrome de Cogan es una entidad poco frecuente, de origen autoinmune.Se caracteriza por queratitis intersticial no sifilítica asociada a síntomasaudiovestibulares similares al síndrome de Ménière. Los primeros síntomas ocularesincluyen enrojecimiento y fotofobia, a los que se puede agregar conjuntivitis o uveítis.Objetivo: Presentar un caso de síndrome de Cogan típico y describir las principalescaracterísticas de la entidad.Caso clínico: Varón, 32 años, sin antecedentes mórbidos. Consulta por cuadro de cuatrodías de evolución caracterizado por dolor ocular e inyección conjuntival. Diagnosticadoen un comienzo con sinusitis y conjuntivitis aguda y se maneja como tal. Alpersistir sintomatología se hospitaliza a la semana evidenciándose fiebre, inyecciónconjuntival bilateral y a los pocos días hipoacusia. Los exámenes de laboratorio destacanleucocitosis, trombocitosis, PCR, VHS e IgA elevadas. Autoanticuerpos y estudiopara VIH y VHC negativos, TAC de cerebro y cavidades paranasales normales. Evaluadopor oftalmología y otorrinolaringología, describiéndose hiperemia conjuntival yquemosis, e hipoacusia neurosensorial de probable origen autoinmune, respectivamente.Evaluado por reumatología, se plantea síndrome de Cogan típico. Se indicaprednisona 1 mg/kg/día, metilprednisolona por dos días y metotrexato semanal, conbuena respuesta. Evoluciona con disminución de cefalea, de compromiso ocular ehipoacusia, afebril, dándose de alta con prednisona y metotrexato. Control al mesdel alta, paciente asintomático, se mantiene tratamiento. Control en oftalmología20 días después, objetivándose leve edema corneal, por lo que se indica tratamientotópico...

Background: Cogan’s syndrome is a rare entity of autoimmune origin. It is characterizedby non-syphilitic interstitial keratitis associated with audiovestibular symptomssimilar to Meniere’s syndrome. Early symptoms include eye redness and photophobia,which can be added conjunctivitis or uveitis.Objective: To report a case of typical Cogan’s syndrome and describe the main featuresof the entity.Case report: Male, 32, no morbid history. Consults for story of 4 days of evolutioncharacterized by eye pain and conjunctival injection. Initially diagnosed with sinusitisand acute conjunctivitis and handled as such. By persisting symptoms is hospitalizeda week later demonstrating fever, bilateral conjunctival injection and in a few dayshearing loss. Laboratory tests include leukocytosis, thrombocytosis, and elevatedPCR, VHS and IgA. Autoantibodies, HIV and HCV study were negative, brain and sinusesCT normal. Reviewed by ophthalmology and otolaryngology, describing conjunctivalhyperemia and chemosis, and sensorineural hearing loss of probable autoimmuneorigin, respectively. Evaluated by rheumatology, typical Cogan’s syndrome arises. It isindicated prednisone 1 mg/kg/day, methylprednisolone for 2 days and weekly methotrexate,with good response. Evolves with decreased in headache, eye commitmentand hearing loss, afebrile, was discharged with prednisone and methotrexate. Controla month after discharge, asymptomatic, treatment is maintained. Control 20 days laterin ophthalmology, objectifying mild corneal edema, so topical treatment indicated...

[Breastfeeding as a protective factor against overweight and obesity among pre-school children]. / Lactancia materna como factor protector de sobrepeso y obesidad en preescolares.

INTRODUCTION: The rates of overweight and obesity among children have significantly increased in Chile. OBJECTIVE: To assess the benefits of breastfeeding in preventing malnutrition by excessive intake of foods in Chilean pre-school children. METHODS: A case-control study was conducted in 2011 on pediatric patients treated in a private Chilean healthcare center (San Joaquin Medical Center, Catholic University). Gender, age, weight, height, nutritional diagnosis, type of feeding during the first 6 months of life, socioeconomic status, parental education and obesity, television viewing, and kindergarten attendance were analyzed. RESULTS: A total of 209 patients were included in the study, 53.1% of whom were male, and 60.3% were predominantly breastfed for the first 6 months of life. More than half (51.7%) were eutrophic, 29.7% were overweight, and 18.6% obese. The patients were between the ages of 2 and 3 years 11 months. The crude Odds Ratio of breast-feeding versus formula during the first 6 months of life in patients with normal weight versus overweight children was 0.442 (95% CI 0.204-0.961). CONCLUSIONS: It was found that predominantly breastfeeding during the first 6 months of life acted as a protective factor against malnutrition by excessive intake of foods in Chilean pre-school children treated in this private medical center.

Lactancia materna como factor protector de sobrepeso y obesidad en preescolares / Breastfeeding as a protective factor against overweight and obesity among pre-school children

Introducción: El sobrepeso y la obesidad infantil han aumentado de forma importante en la población pediátrica chilena. Objetivo: Comprobar los beneficios de la lactancia materna en la prevención de la malnutrición por exceso en preescolares chilenos. Pacientes y Método: Estudio caso-control efectuado el año 2011 en pacientes pediátricos controlados en un centro privado de Chile (Centro Médico San Joaquín; Pontificia Universidad Católica). Se consignó sexo, edad, peso y talla, diagnóstico nutricional, tipo de alimentación durante los primeros 6 meses de vida, nivel socioeconómico, educación y obesidad de los padres, horas frente al televisor y asistencia a jardín infantil. Resultados: Se incluyeron 209 pacientes: el 53,1% eran de sexo masculino y el 60,3% recibieron lactancia materna predominante durante los primeros 6 meses de vida. Entre los 2 años y los 3 años y 11 meses, el 51,7% era eutrófico, el 29,7% presentó sobrepeso y un 18,6% obesidad. La odds ratio cruda de exposición a alimentación con lactancia materna versus fórmula láctea predominante durante los primeros 6 meses de vida en pacientes con malnutrición por exceso versus eutróficos fue de 0,442 (intervalo de confianza [IC] del 95%, 0,204-0,961). Conclusiones: Se verificó que la lactancia materna predominante los primeros 6 meses de vida actuó como factor protector contra malnutrición por exceso en niños preescolares chilenos tratados en este centro médico privado.

Introduction: The rates of overweight and obesity among children have significantly increased in Chile. Objective: To assess the benefits of breastfeeding in preventing malnutrition by excessive intake of foods in Chilean pre-school children. Methods: A case-control study was conducted in 2011 on pediatric patients treated in a private Chilean healthcare center (San Joaquin Medical Center, Catholic University). Gender, age, weight, height, nutritional diagnosis, type of feeding during the first 6 months of life, socioeconomic status, parental education and obesity, television viewing, and kindergarten attendance were analyzed. Results: A total of 209 patients were included in the study, 53.1% of whom were male, and 60.3% were predominantly breastfed for the first 6 months of life. More than half (51.7%) were eutrophic, 29.7% were overweight, and 18.6% obese. The patients were between the ages of 2 and 3 years 11 months. The crude Odds Ratio of breast-feeding versus formula during the first 6 months of life in patients with normal weight versus overweight children was 0.442 (95% CI 0.204-0.961). Conclusions: It was found that predominantly breastfeeding during the first 6 months of life acted as a protective factor against malnutrition by excessive intake of foods in Chilean pre-school children treated in this private medical center.

Fiebre de Chikungunya: reporte de tres casos del Hospital Naval Almirante Nef / Chikungunya fever: report of three cases from Almirante Nef Naval Hospital

Chikungunya fever is an emerging infection in our country due to travelers to endemic areas. It presents acutely with high fever, fatigue, headache, myalgia, skin rash and arthritis, usually as a symmetric polyarthritis compromising the interphalangeal and metacarpophalangeal joints, wrist, elbow, ankle and knee. While most of the symptoms last about a week, arthralgias may become chronic and generate significant functional impairment. Chikungunya has been postulated as a triggering factor for rheumatoid arthritis because of the presence of positive rheumatoid factor. We present the three confirmed cases in Almirante Nef Naval Hospital with the review of the published literature...

La fiebre de Chikungunya es una infección novedosa en nuestro país pues su contagio se produce por viajeros en zonas endémicas. Se presenta generalmente en forma aguda con fiebre alta, astenia, cefalea, mialgia, rash cutaneo y artritis, mayoritariamente como poliartritis simétrica comprometiendo las articulaciones interfalángicas, metacarpofalángicas, muñecas, codos, tobillo y rodillas. Si bien la mayoría de los síntomas duran aproximadamente una semana, las artralgias pueden hacerse crónicas y generar un importante deterioro funcional. Se ha postulado que podría ser un factor gatillante de artritis reumatoide ante la presencia de factor reumatoideo positivo. A continuación se presentan los tres casos confirmados del Hospital Naval Almirante Nef junto a la revisión de la literatura publicada hasta el momento...

Within-farm spread of infectious salmon anemia virus (ISAV) in Atlantic salmon Salmo salar farms in Chile.

Spread of infectious salmon anemia virus (ISAV) at the cage level was quantified using a subset of data from 23 Atlantic salmon Salmo salar farms located in southern Chile. Data collected from official surveillance activities were systematically organized to obtain detailed information on infectious salmon anemia (ISA) outbreaks. Descriptive statistics for outbreak duration, proportion of infected fish, and time to secondary infection were calculated to quantify the magnitude of ISAV incursions. Linear and multiple failure time (MFT) regression models were used to determine factors associated with the cage-level reproduction number (Rc) and hazard rate (HR) for recurrent events, respectively. In addition, the Knox test was used to assess if cage-to-cage transmissions were clustered in space and time. Findings suggest that within farms, ISA outbreaks, on average, lasted 30 wk (median = 26 wk, 95% CI = 24 to 37 wk) and affected 57.3% (95% CI = 47.7 to 67.0%) of susceptible cages. The median time to secondarily diagnosed cages was 23 d. Occurrence of clinical ISAV outbreaks was significantly associated with increased Rc, whereas increased HR was significantly associated with clinical outbreaks and with a large number of fish. Spatio-temporal analysis failed to identify clustering of cage cases, suggesting that within-farm ISAV spread is independent of the spatial location of the cages. Results presented here will help to better understand ISAV transmission, to improve the design of surveillance programs in Chile and other regions in which salmon are intensively farmed, and to examine the economic impact of ISAV and related management strategies on various cost and demand shifting factors.

Co-infection patterns of infectious salmon anaemia and sea lice in farmed Atlantic salmon, Salmo salar L., in southern Chile (2007-2009).

Infectious salmon anaemia virus (ISAV) caused a large epidemic in farmed Atlantic salmon in Chile in 2007-2009. Here, we assessed co-infection patterns of ISAV and sea lice (SL) based on surveillance data collected by the fish health authority. ISAV status and SL counts in all Atlantic salmon farms located in the 10th region of Chile were registered monthly from July 2007 through December 2009. Each farm was categorized monthly according to its ISAV and SL status. A multinomial time-space scan test using a circular window was applied to identify disease clusters, and a multivariate regression model was fitted to quantify the association between disease-clustering and farm-management factors. Most of the identified clusters (9/13) were associated with high SL burdens. There were significant associations (P < 0.05) between management factors and ISAV/SL status. Areas in which good management practices were associated with a reduced disease risk were identified. The findings of this study suggest that certain management practices can effectively reduce the risk of SL and ISAV in the face of an epidemic and will be helpful towards creating an effective disease control programme in Chile.

Resección de metástasis pulmonares / Resection of lung metastases

Surgical treatment of lung metastases (LM) is a therapy used for several types of metastatic cancers. However, the type of surgery and its outcome is controversial. Aim: To describe a series of patients with LM undergoing surgical treatment, their results and long-term follow up. Material and Methods: We retrospectively reviewed all the medical records of patients with the diagnosis of LM, of whatever origin, operated at our hospital between the years 2002 and 2008. We analyzed their clinical characteristics, treatment, morbidity, mortality and results. Results: During this period 24 patients with LM were operated. The mean age was 52.8 +/- 16.6 years. Most patients had kidney cancer as primary tumour. The usual clinical presentation was multiple bilateral nodules. The surgical approach was in general a video-thoracoscopy (40.9 percent) associated with a wedge resection of the lesions (81.8 percent). In 83.4 percent of cases, there were no post-operative complications. Seventy six percent of the patients relapse, in an average of 16.7 +/- 12 months and 68.7 percent were reoperated for a new resection. The probability of surviving more than 3 and 5 years post metastasectomy was 57 percent and 36 percent respectively. Conclusions: In this series the LM were mostly secondary to renal cancer. The video-thoracoscopy is an emergent and safe technique in the treatment of LM, being the main type of surgical approach in our patients. Despite the high percentage of reoperations, the survival rate is comparable to the rest of the published series.

El tratamiento quirúrgico de las metástasis pulmonares (MP) constituye una terapia usada para varios tipos de cánceres metastásicos. Sin embargo, el tipo de cirugía y sus resultados es controversial, por lo que hemos decidido estudiarla. Objetivo: Describir clínicamente una serie de pacientes con MP sometidos a tratamiento quirúrgico, sus resultados y seguimiento a largo plazo. Material y Método: Se revisaron retrospectivamente las fichas de pacientes con el diagnóstico de MP, de cualquier origen, operados en nuestro hospital entre los años 2002 y 2008. Se analizaron las características clínicas, tratamiento, morbimortalidad y resultados. Resultados: Durante este período se operaron 24 pacientes por MP. El promedio de edad fue 52,8 +/- 16,6 años. La mayoría de los pacientes tenía un cáncer renal como tumor primario. La forma habitual de presentación fueron múltiples nodulos bilaterales. El abordaje quirúrgico más frecuente fue por videotoracoscopía (40,9 por ciento) asociado a una resección en cuña de las lesiones (81,8 por ciento). En el 83,4 por ciento no hubo complicaciones post operatorias. El 76,4 por ciento de los pacientes recidivó, en promedio a los 16,7 +/-12 meses y el 68,7 por ciento fue reintervenido para una nueva resección. La probabilidad de sobrevivir más de 3 y 5 años post me-tastasectomía fue de 57 por ciento y 36 por ciento respectivamente. Conclusiones: En esta serie las MP fueron principalmente secundarias a cáncer renal. La videotoracoscopía es una cirugía emergente y segura en el tratamiento de las MP, siendo la principal forma de abordaje quirúrgico en nuestros pacientes. A pesar del elevado porcentaje de reintervenciones, la sobrevida es comparable al resto de las series publicadas.

Monitoring endocrine activity in kraft mill effluent treated by aerobic moving bed bioreactor system.

A Moving Bed Bioreactor (MBBR) was operated at three different hydraulic retention times for a period of 414 days. The fate of the extractive compounds and the estrogenic activity of the Pinus radiata kraft mill effluents were evaluated using Yeast Estrogen Screen (YES) and gas chromatography - mass spectrometry (GC-MS) detection. Results show that the MBBR reactor is able to remove between 80-83% of estrogenic activity present in the kraft mill Pinus radiata influent, where the values of the effluent's estrogenic activity ranged between 0.123-0.411 ng L(-1), expressed as estrogenic equivalent (EEqs) of 17-a-ethynylestradiol (EE2 eq.). Additionally, the biomass of the MBBR reactor accumulated estrogenic activity ranging between 0.29-0.37 ng EEqs EE2 during the different Hydraulic Retention Time (HRT) operations. The main groups present in pulp mills effluents, corresponding to fatty acids, hydrocarbons, phenols, sterols and triterpenes, were detected by solid phase extraction (SPE) and gas chromatography - mass spectrometry (GC-MS). The results suggest that the sterols produce the estrogenic activity in the evaluated effluent.

Aerobic moving bed bioreactor performance: a comparative study of removal efficiencies of kraft mill effluents from Pinus radiata and Eucalyptus globulus as raw material.

A Moving Bed Bioreactor (MBBR) was operated during 333 days. Two different effluents were fed in six different phases. Phases I and II were fed with effluent where Pinus radiata was used as raw material, while phases III to VI were fed with effluent where Eucalyptus globulus was used as raw material. The HRT was reduced from 85 to 4 h, and the BOD(5):N:P ratio (100:5:1, 100:3:1 and 100:1:1) was also simultaneously evaluated as an operation strategy. When MBBR was operated with Pinus radiata influent, the performance presents a high BOD(5) removal level (above 95%), although COD removal is below 60%. Most of the recalcitrant COD contained in the effluent has a molecular weight higher than 10,000 Da. When MBBR was operated with Eucalyptus globulus influent, the performance is around 97.9-97.6% and 68.6-65.1% for BOD(5) and COD, respectively (with HRT up to 17 h). In the Pinus radiata and Eucalyptus globus effluents, the color was mainly found in the molecular weight fraction up to 10,000 Daltons.

Evaluación de la comunicación entre el equipo médico y los familiares de los pacientes hospitalizados en UCI / Evaluation of communication between medical equipment and intensive care unit patient families

Introducción: Una labor importante del médico intensivista es su capacidad para comunicarse con la familia del paciente crítico en forma clara, directa y empática, a fin de lograr mejor calidad en la atención. No existen estudios a nivel nacional que evalúen la calidad de la comunicación médico-familia en UCI. Objetivo: Diagnóstico de situación sobre la calidad de la comunicación entre la familia del paciente hospitalizado en UCI y el equipo médico de salud. Método: Estudio descriptivo, prospectivo, doble ciego. Aplicación de encuesta de opinión validada internacionalmente a familiares del paciente hospitalizado en la UCI General por un período de 72 horas o más entre los meses de marzo a mayo del 2002. Los datos fueron expresados en porcentajes. Se utilizó test de Anova para determinar diferencia de medias y obtener grado de significancia estadística. Resultados: Se aplicó la encuesta a 51 personas visitantes de un total de 20 pacientes en UCI. De los encuestados, 60,7 por ciento eran mujeres y 39,2 por ciento hombres; 74,6 por ciento familiares directos y 25,4 por ciento otros visitantes; 37,2 profesionales y 62,8 por ciento no profesionales. Un 98 por ciento piensa que la información siempre o la mayor parte del tiempo es dada en términos que se pueda entender, honesta y suficiente. Un 60 por ciento de los familiares reconoce al equipo de salud siempre o la mayor parte del tiempo y cerca del 100 por ciento considera que siempre o la mayor parte del tiempo se le está dando la mejor atención a su familiar y que el equipo de salud se preocupa por él. Entre 74 y 80 por ciento de los entrevistados considera que el médico siempre es cortés y tiene disponibilidad para recibirlo. El grupo de profesionales se encuentra menos satisfecho en este aspecto que el grupo de no profesionales (p<0,01). El grupo de otros visitantes del paciente se siente en un 100 por ciento cómodo al visitar al paciente en la UCI, a diferencia de los familiares directos que en 15 por ciento se sentían cómodos sólo algunas veces o nunca (p< 0,01). Conclusiones: En nuestro estudio la familia evalúa la comunicación con el equipo médico, su disponibilidad y cortesía en la atención de mejor forma que lo expresado en la literatura. El grupo de los profesionales se encuentra menos satisfecho en cuanto a la disponibilidad o cortesía por parte del médico.