Programa de transición: evaluación de un modelo a 4 años de su implementación / Transition program: evaluation of a model 4 years after its implementation

INTRODUCCIÓN: La evaluación de los programas de transición (PT) es un paso fundamental para determinar su importancia como estrategia de seguimiento y apoyo a los adolescentes con diabetes tipo 1 (DM1) que transitan de una atención pediátrica a una adulta. OBJETIVO: evaluar un modelo de PT para adolescentes con DM1 a 4 años de su implementación. SUJETOS Y MÉTODO: este estudio se realizó en 65 adolescentes que ingresaron al PT. Se evaluó el cumplimiento de los indicadores de adherencia del PT (preparación, continuidad, regularidad, exclusividad en la atención médica y seguimiento psicológico), la participación de los adolescentes en el PT (cumplir con los 5 indicadores) y el control metabólico asociado a esa participación. El análisis estadístico se realizó con Prueba de Chi Cuadrado para las variables grados de participación y control metabólico; y Prueba T de Student para muestras pareadas para evaluar la variación de HbA1c al finalizar el primer año en atención como adulto. RESULTADOS: los indicadores de adherencia del PT se cumplen sobre el 65% en la población estudiada. Se encontró que el 38,5% de los adolescentes logran participación completa en el PT (cumplir 5 indicadores), 43,1% participación parcial (cumplir 3 o 4 indicadores) y 18,4% participación insuficiente en el PT (cumplir con 0, 1 ó 2 indicadores). Se observó una mayor frecuencia de mantenimiento o mejoría del control metabólico en los adolescentes con participación completa en el PT en comparación con los de participación parcial e insuficiente (76% v/s 59,2% y 22,2% respectivamente). Se observó un cambio significativo (p < 0,05) de la HbA1c en adolescentes con participación completa y participación parcial. CONCLUSIÓN: en los adolescentes con DM1, se debe incentivar la participación en el PT para fortalecer las conductas de adherencia al tratamiento diabético incluyendo el control metabólico.

INTRODUCTION: the evaluation of the transition programs (TP) is a fundamental step to determine its importance as a follow-up and support strategy for adolescents with type 1 diabetes (T1D) who move from a pediatric to adult care. OBJECTIVE: to evaluate a TP model for adolescents with T1D 4 years after its implementation. SUBJECTS AND METHOD: this study was carried out in 65 adolescents who entered the TP. Compliance with the TP adherence indicators was evaluated (preparation, continuity, regularity, exclusivity in medical care and psychological follow-up), the participation of adolescents in the TP (compliance with the 5 indicators) and the metabolic control associated with that participation. The statistical analysis was carried out with Chi-square test for the variable degrees of participation and metabolic control; and paired Student's T test for the change of HbA1c at the end of the first year in adult. RESULTS: TP adherence indicators are met over 65% in the population studied. When evaluating participation in the TP, it was found that 38.5% of adolescents achieved full participation in the TP (meet 5 indicators), 43.1% partial participation (meet 3 or 4 indicators) and 18.4% insufficient participation in the TP (comply with 0, 1 or 2 indicators). A higher frequency of maintenance or improvement of metabolic control was observed in adolescents with full participation in the TP compared to those with partial and insufficient participation (76% v/s 59.2% and 22.2% respectively). The statistical difference (p < 0.05) was obtained in the change of HbA1c of adolescents with full participation and partial participation. CONCLUSION: in adolescents with T1D, participation in TP should be encouraged to strengthen adherence to diabetic treatment including metabolic control.

Disforia de género: la evaluación psicológica para un cambio de sexo de hombre a mujer / Gender dysphoria: the psychological evaluation for a change of sex from male to female

La disforia de género es una condición psicológica que requiere una evaluación específica para definir el cambio de sexo. Se describe el caso de un adulto de sexo biológico masculino de 50 años de edad que se atiende en una Unidad de Atención de personas viviendo con VIH-SIDA quien es derivado para una evaluación psicológica por fiscalía. Se realizaron entrevistas en profundidad y la aplicación de las siguientes pruebas psicológicas: test de Rorschach, test de los colores de Max Lüscher y el Cuestionario Desiderativo. Se concluyó una prueba de realidad conservada, presencia de estabilidad emocional y una identificación profunda con el sexo femenino, elementos claves para proceder al cambio de sexo.

Gender dysphoria is a psychological condition that requires a specific evaluation to define the sex change. We describe the case of a 50-year old adult male biological sex that is treated in a Unit of Care for people living with HIV-AIDS who is referred for a psychological evaluation by a public prosecutor's office. In depth interviews and the application of the following psychological tests were carried out: Rorschach test, Max Lüscher color test and the Desiderative Questionnaire. A conserved reality test, presence of emotional stability and a deep psychological identification with the female sex, key elements to proceed to the sex change, was concluded.

Programa de transición: una intervención para adolescentes con diabetes tipo 1: estudio de casos y controles / Transition program: an intervention for adolescents with type 1 diabetes: cases and controls study

Introduction: The transition programs (TP) are planned interventions with specific aims which support type 1 diabetes adolescents in their process to emigrate from a pediatric care system to an adult care system. Objective: To evaluate the effectiveness of a TP in type 1 diabetes adolescents. Subjects and Method: This study was performed in 20 adolescents: 10 in TP and 10 controls (no TP) attended in an adult care system in a traditional way. The applied program included: coordination of attention dates, administrative supervision of the cases, and integral health team attention: physician every three months, psychologist with psychosocial follow-up every three months, nutricionist and university nurse according to the case necessities. After a year of the TP implementation the indicators of adherence were evaluated: continuity of care, regular medical appointments, physician/adolescent relationship, psychosocial follow-up, and to maintain or improve the HbA1c. The statistical analysis of variables comparison was performed with Kwallis Test o Mann-Whitney Test, in STATA 12.0 program. Results: At comparing groups, it was found that the intervened adolescents presented a major frequency of: continuity of diabetes care, regular medical appointments, physician/adolescent relationship and psychosocial follow-up (p < 0,01); the indicator of maintaining or improving the HbA1c was better in the patients with TP (60 percent vs 30 percent) yet not significant. Conclusion: In type 1 diabetes adolescents, with the applied TP we get better indicators of adherence to the diabetes treatment

Experiencia con insulina degludec en pacientes diabéticos Tipo 1 del Hospital San Juan de Dios Santiago / Experience with degludec insulin in Type 1 diabetic patients at the San Juan de Dios Hospital

OBJECTIVE: To study the efficacy and safety of degludec insulin in Type 1 diabetic patients. PATIENTS AND METHOD: In a prospective study, 230 type 1 diabetics patients, average aged 34 years age and 14 years of diagnosis of diabetes and treated with two doses of insulin glargine U-100, were changed to degludec. Patients had glycosylated hemoglobins (HbA1c) greater than 10 percent. Results were recorded at 3 and 6 months with parameters clinical, biochemical, insulin requirements per kilogram of weight (U/kg/wt) and hypoglycemia. Capillary glycemia was evaluated three times a day and the dose of insulin degludec every two weeks. The statistical analysis used was average and rank, standard deviation, normal Swilk test, categorical Chi2 and continuous ANOVA or Kwallis, and p < 0.05. A psychological survey was conducted to evaluate satisfaction with the new treatment. RESULTS: Fasting blood glucose decreased from 253 (range 243-270) at 180 mg/dl (172-240) at 3 months and at 156 (137-180) at 6 months after the change insulin (p < 0.05). HbA1c, initially 10.6 percent (10.4-12.2) decreased to 8.7 percent (9.3-10.1) and 8.3 percent (8.7-9.7) at 3 and 6 months, respectively (p < 0.05). There was a decrease in basal insulin requirements from 0.7 to 0.4 U/kg/60 percent reduction in hypoglycaemia; both mild and moderate and severe. Isolated nocturnal hypoglycaemias were recorded in only 4 patients in this group. CONCLUSION: Six months of treatment with degludec insulin reduces fasting blood glucose, glycosylated hemoglobin and hypoglycemia, both mild and moderate severe and nocturnal, which makes this new ultra-long acting basal insulin a safe and effective tool for the management of type 1 diabetics patients

Contaminación por mohos y aislamiento de cladosporium spp. y thamnidium spp. en cámaras frigoríficas de plantas procesadoras de alimentos marinos y empresas frigoríficas del sur de Chile / Mould contamination and isolation of cladosporium spp. and thamnidium spp. in frigorific chambers of sea-food processing plants and frigorific enterprises from South of Chile

La apertura de nuevos mercados para los productos hidrobiológicos chilenos ha impuesto el análisis del estatus sanitario de cámaras frigoríficas donde estos productos son almacenados. Para medir el estatus sanitario, la Unión Econó- mica Euroasiática (UEE) exige un recuento total de mohos e identificación de los géneros Cladosporium y Thamnidium en paredes y ambiente de las cámaras frigoríficas. Poco se sabe sobre los niveles de contaminación de mohos en cámaras frigoríficas de productos de exportación en Chile. Aquí, los resultados de 88 análisis de mohos en paredes y aire, realizados a 24 empresas diferentes que poseen cámaras frigoríficas conteniendo productos hidrobiológicos, son mostrados. El recuento total de mohos y el número de colonias de Cladosporium spp. y Thamnidium spp. fueron determinados. Además, los niveles de contaminación por mohos fueron comparados entre plantas procesadoras de alimentos y empresas frigoríficas. Thamnidium spp. no fue encontrado en ninguno de los análisis realizados. Los resultados indican que los niveles de contaminación por mohos son aceptables para la UEE. Este es el primer reporte de niveles de contaminación de mohos en cámaras frigoríficas de productos hidrobiológicos en el sur de Chile.

The opening of new markets for Chilean hydrobiological products had imposed the analysis of the sanitary status of frigorific chambers where those products are kept. To measure the sanitary status, the Euroasiatic Economical Union (EEU) requires a total mould count and identification of Cladosporium and Thamnidium in walls and air of the frigorific chambers. Little is known about contamination levels of moulds in frigorific chambers of export products in Chile. Here, the results of 88 mould analyses in walls and air, performed to 24 different enterprises that possess frigorific chambers containing hydrobiological products, are shown. Total mould count and Cladosporium spp. and Thamnidium spp. colony number were determined. Additionally the levels of moulds contamination were compared between food-processing plants and frigorific enterprises. Thamnidium spp. was not found in any of the analyses performed. The results indicate that levels of moulds contamination are acceptable to the EEU. This is the first report of mould contamination levels in frigorific chambers of hydrobiological products from south of Chile.

Transición en diabetes tipo 1: evaluación y tratamiento psicosocial. Caso clínico / Transition in type 1 diabetes: psychosocial evaluation and treatment. case report

Healthcare transition from a pediatric clinic to an adult clinic can represent a challenge for the health teams who work with chronic pathologies. This case describes a 15,3 years old adolescent with type 1 diabetes, attended by a pediatrician since the beginning of his diagnosis at 8 years old. The psychological evaluation was performed with tests: the person in the rain, the Lüscher colors and the Millon personality inventory before and after one year of psychosocial treatment. It was achieved improvement in his psychosocial functioning (empathy, self-affirmation, emotional regulation, relationships) and his metabolic control, enabling recommend his transfer to adult diabetologist.

[Duodenogastric reflux: validation study of its endoscopic visualization]. / Reflujo duodenogástrico: estudio de validación de su visualización endoscópica.

BACKGROUND: Duodenogastric reflux is a normal event that can be deleterious to the esophagic or gastric mucosa, depending on its magnitude, persistence, composition and gastric pH. There is not a definitive method to measure this phenomenon. AIM: To compare the endoscopic visualization of duodenogastric reflux with the quantitation of total bile acids in fasting gastric content (QTBA). PATIENTS AND METHODS: The presence of duodenogastric reflux, defined as the staining of gastric walls with bile during upper gastrointestinal endoscopy, was assessed in 62 patients (26 male), aged 21 to 73 years old. During the week after the endoscopy a sample of fasting gastric content was obtained to measure QTBA, using an enzymatic method. RESULTS: Median QTBA was 0.205 mumol/gastric residue. Fourteen of 31 patients with QTBA values over the median had endoscopically visible duodenogastric reflux, whereas 1 of 31 with values below the median had visible reflux (p < 0.001). CONCLUSIONS: Endoscopic visualization of duodenogastric reflux is statistically associated to the quantitation of total bile acids in fasting gastric residue.

Causes and signs of temporomandibular joint pain and dysfunction: an electromyographical investigation.

The spontaneous muscular activity of the masseter and two non-masticatory muscles, and their activity under conditions of noise and flickering light, were recorded in 30 patients with mandibular dysfunction, and in 25 control subjects. The mood of the subjects during the investigation, and the possible presence of emotional disturbances was evaluated by means of questionnaires. The enhanced muscular activity of the masseter muscle differentiated patients from the control group, although it does not constitute a pathognomic sign. Unilaterality of complaints, and dysfunctions of differing intensity were not reflected in differential EMG findings. One-fifth of the patients exhibited neck muscle activity occurring simultaneously with the masseter activity. The effect of the applied stimuli on the muscular activity was not homogeneous, leading to activation in some cases and inhibition in others. Symptoms of anxiety could be observed in seven TMJ patients. Anxious patients showed higher levels of muscular activity and emotional irritability during the experiment than non-anxious patients.

[Transmediastinal esophagectomy without thoracotomy in cancer of the esophagus]. / Esofagectomía transmediastinal sin toracotomía en cáncer del esófago.

Between 1987 and 1990 twenty report cases who suffered carcinoma of the esophagus underwent transmediastinal esophagectomy without thoracotomy at the Surgery Service of the Edgardo Rehabilitation Hospital. Of the report cases 90% were at stage III, 5% of stage II and 5% at stage I of the TNM Classification. Post operative complications were cervical leaks, transitory dysphonia and respiratory illness, and were solved by conservative management. Only one case died with sepsis and mediastinitis, this represents an inpatient mortality of 5%. There were no hemorrhagic complications, nor chylothorax neither visceral necrosis during surgical time. Transmediastinal esophagectomy offers a good choice for the management of surgical cases, it has low mortality, morbidity and similar survival time than other procedures.

[Caustic esophagitis: surgical management]. / Esofagitis caústica: manejo quirúrgico.

The authors present 28 report cases of severe caustic esophagitis who underwent surgery at the Hospital Nacional Edgardo Rebagliati Martins I.P.S.S., from 1987 to February 1991. All were treated by esophagocoloplasty and when the proximal cervical esophagus was injured, by pharingocoloplasty. Eighteen patients (64.28%) were female and 10 (35.72%) male. Whose ages ranged between 15 and 75 years with an average of 34 years. Ten patients (36%) suffered pharingocoloplasty and in the remaining 18 (64%) a esophagocoloplasty (esophagogastric colonic interposition) was made. Postoperative morbidity corresponded in 5 cases (18%) to respiratory Infections, in 3 cases (11%) pneumothorax, in 2 cases (7%) pleural effusions and only one case presented a small cervical leak. All of them were satisfactory solved by conservatory medical treatment. Only two cases (7%) with late postoperative stenosis required reintervention and a simple cervical plasty was made. There were no complications as mediastinitis, necrosis of the colon graft hemorrhage. Operatory mortality was 0% and the long term follow up of all patients is satisfactory, having our first report cases more than 4 years of postoperative follow up.

Eye and head movements to visual and auditory targets.

Coordinated eye-head movements evoked by the presentation of visual, auditory and combined audio-visual targets were studied in 24 human subjects. At 60 deg located targets latencies of eye and head movements were shorter for auditory than for visual stimuli. Latencies were shorter for bisensory than for monosensory targets. The eye and head latencies were differently influenced by the modality of the stimulus when the eccentricity of the target was changed, but not by the variation of the stimulus duration. The different responses of the eye and the head depending on target modality and target eccentricity can be partially attributed to perceptual and central processing mechanisms, and are important to answer the question about the initial event in coordinated eye-head orientation.

A qualitative analysis of emotional effector patterns and their feedback.

This paper is devoted to the study of the relationship between the subjective component (feelings) and the behavioral aspect of emotions. The following emotions were studied: fear-anxiety, anger-aggression, joy-laughter, love-eroticism, love-tenderness, and sadness-tears. The observations were performed with three different groups of people: patients with anxiety neurosis, students under hypnosis, and drama students. Each emotion was characterized by a specific set of reactions in the respiratory pattern, heart activity, muscular activity, and facial expression. The feelings were correlated with the behavioral patterns and each time the behavioral patterns were interfered with a concomitant modification of the subjectivity component was observed. The direct performance of the behavioral emotional patterns in the absence of the emotogenic stimulus produced the feeling corresponding to the mimicked emotion. If the subjects were stimulated with an emotogenic stimulus during the direct performance of the behavioral patterns of another emotion, they confessed to have the feeling corresponding to the mimicked emotion, and not to the emotion belonging to the emotogenic stimulus. The role played by the feedback from the effector organs in the determination of the subjective emotional states is discussed.

Audio-visual targeting reaction after unilateral lesions of the superior colliculus in cats.

Cats were trained to visually localize one of eight loudspeakers distributed in different spatial locations. The animals localized the activated sound source through a directed movement of ears, eyes and head towards it. The number of correct targeting reactions triggered by a tone stimulus from different spatial positions was strongly impaired in the operated animals in comparison to controls. The number of correct responses was higher when the tone stimuIus was presented from the side of the lesion. The role of the superior colliculus in the integration of audio-visual targeting reaction is discussed.

Effector pattern of the audio-visual targeting reflex in cats.

The development of the effector pattern of the unconditioned and instrumental conditioned audio-visual targeting reflex was studied. EOG and EMG electrodes were implanted to analyze the movements of the pinna, eye and head, when the animals localized a sound source placed in different positions in space. When the acoustic stimulus was repeated, the unconditioned targeting reflex was characterized by a rapid intra- and intersessional habituation of the three motor components. In the second part of the experiment the unconditioned targeting reflex was reinforced by food to build up an instrumental conditioned targeting reflex. It was shown, that under both experimental conditions the targeting reflex began with the auricular component, followed by the oculo-cephalic response. After conditioning the latencies were decreased in comparison with the unconditioned reactions. The shortest latencies and most stable responses were found in the pinna muscles ipsilateral to the sound source. After conditioning the resistance to extinction was increased for all three motor components, but the pinna movement ipsilateral to the sound source was again the component most resistant to extinction.

Effects of motor denervation of the external ear muscles on the audio-visual targeting reflex in cats.

The effect of uni- and bilateral denervation of muscles of the pinna on the audio-visual targeting reflex reinforced by food was studied. In comparison with the normal group the unilaterally denervated animals showed a decreased capacity to localize sound sources placed behind the animal ipsi- and contralaterally to the operated side. The denervation of the second ear in these animals induced a further decrease of the localization scores, especially of the sources placed behind them. The localization behavior strategies were different depending on the integrity of the innervation of muscles of the pinna. The stimulation of the operated side with tones of a 30 dB higher intensity than in the normal side did not improve the animals’performance in localizing the sound sources. The shortening of duration from 500 to 50 ms reduced, the capacity to localize the loudspeakers placed ipsilaterally to the denervated side, especially those behind the animal. The role for the targeting reflex of the feedback information from the muscles controlling the pinna movements, and the significance of the postural changes induced by the tone are discussed.

Conditioned audio-visual targeting reflexes in split brain cats.

A conditioned audio-visual targeting reflex was elaborated in 12 freely moving cats. The cats had to localize the loudspeaker emitting by a tone of 1600 Hz, of 500 ms duration and 80 dB intensity. Each time one of the eight loudspeakers placed in front and behind the cat was activated and the targeting reaction rewarded by food. Normal cats attained the 80 percent criterion for the front and rear loudspeakers in 20 and 30 sessions, respectively. The influence of the transection of the corpus callosum on acquisition and retention of the targeting reaction was investigated. The split brain animals with pre-operative experience in the situation did not show any retention, but relearned the targeting of the frontal sources in 20 sessions. No relearning of the posterior sound sources was observed. The animals that had only post-operative training did not reach 80 percent of correct responses in 50 sessions. Corpus callosum transection influences the integration of the targeting reaction in different ways, depending on the position of the sound source and on pre-operative training.