Determination of the genotype and phenotype of serum paraoxonase 1 (PON1) status in a group of agricultural and nonagricultural workers in the Coquimbo Region, Chile.

Paraoxonase 1 (PON1) is a glycosylated enzyme that is found associated with high-density lipoproteins in blood. In addition to its endogenous antioxidant role, this enzyme is also involved in hydrolysis of organophosphate (OP) pesticides in plasma. PON1 activity shows great variability in the population as a result of a polymorphism in the coding sequence that is expressed as a Glu(Q)/Arg(R) substitution at position 192 of the amino acid sequence. The aim of this study was to determine the activity levels (phenotype) and genotype of PON1 in a group of 85 agricultural workers occupationally exposed to OP pesticides and compared to 97 control subjects without occupational exposure. Allelic and genotypic frequencies of PON1Q192R polymorphism, as well as their catalytic activities, were established for the first time in a group of agricultural Chilean workers. The Q allele was more frequently represented in our studied population (approximately 60%). The Q allele is less efficient than the R allele at metabolizing chlorpyrifos (CPF), the most widely used OP pesticide in the geographical areas where samples were obtained. Further, a large interindividual variability in PON1 activity was observed, suggesting wide variation of individual susceptibility to CPF, an issue that needs to be considered in human monitoring studies.

Priorización de las garantías explícitas en salud: ¿es posible la participación social? / Prioritization of the explicit guarantees in health in Chile: is social participation possible?

Latinoamérica ha sido participe de procesos de reformas en salud caracterizados por los reajustes estructurales del gasto en salud y la descentralización de los servicios de salud. Como consecuencias de estos cambios, en Chile a finales de la década de los setenta y gran parte de la del ochenta se implementaron cambios al sistema de salud basados en la política de reajuste estructural. Así, en la década de los noventa el país implementó estrategias para recuperar la inversión sectorial, mejorar infraestructura y la accesibilidad a los servicios de salud producto de los cambios de la década anterior. Actualmente, Chile implementa una reforma dirigida al establecimiento de un proceso de priorización de garantías explícitas y exigibles para los ciudadanos, la mejora del modelo atención y de la gestión del sistema, y la implementación de la participación social en salud. Si bien la relación entre los procesos de priorización en salud y la participación social ha sido ampliamente declarada, no existe consenso respecto de los beneficios de incluir a la ciudadanía en dichos procesos. En el caso de la priorización de las Garantías Explícitas en Salud en Chile, la participación en la priorización de las garantías parece difícil en razón de las exigencias técnicas del proceso. El presente artículo tiene por objetivo el discutir de si de todos modos es posible la participación social en salud dentro del proceso de priorización de intervenciones con Garantías Explícita en Salud, en el actual escenario de implementación de la reforma de salud en Chile.

Latin America has participated in health reform processes characterized by the structural adjustments of the cost in health and the decentralization of health services. In Chile, in the late 70’s and most of the 80’s, changes to the health system were implemented based on the structural readjustment policy. In the 90’s strategies were implemented in Chile to recover both the infrastructure and the accessibility of the health services. At present, Chile is implementing a reform based on a list of prioritized health problems, the treatment of which can be claimed as a legal universal right on the improvement of the health care.

Cambio climático y enfermedades infecciosas: un nuevo escenario epidemiológico / Climate change and infectious diseases: a novel epidemiological scenario

For the international scientific community, it is undoubted that planetary temperature is increasing, being projected an average raise of 1.0 °C-3.5 °C by the year 2100. Forecasted consequences are diverse, most of them adverse for human health, including the establishment of favorable epidemiological scenarios for the emergence and reemergence of infectious diseases. The present article summarizes the available evidence regarding the mechanisms that promote climate change, its environmental effects and its consequences on human health. In order to accomplish this objective, demonstrated changes in the dynamics of zoonotic, vectorial, food and water-borne diseases are described. The position of Chile in the international community is commented, as well as múltiple pending challenges, among which outstands the importance of incorporating professionals that work in the health sector to the national debate.

Para la comunidad científica mundial, el aumento progresivo de la temperatura del clima planetario es un hecho inequívoco, proyectándose para el año 2100 un incremento de la temperatura promedio de 1,0 °C - 3,5 °C. Las consecuencias pronosticadas son muy diversas, siendo en su mayoría adversas para la salud humana, entre las cuales se incluyen el establecimiento de escenarios epidemiológicos propicios para la emergencia y reemergencia de enfermedades infecciosas. El presente artículo sintetiza la evidencia disponible en torno a los mecanismos generadores del cambio climático, sus efectos medioambientales y sus consecuencias sobre la salud humana. Para ello, se describen cambios ya objetivados en la dinámica de enfermedades zoonóticas y vectoriales y de enfermedades transmitidas por agua y alimentos. Se comenta la posición de Chile en el concierto internacional y sus múltiples desafíos pendientes, destacándose la importancia de incorporar al debate nacional a profesionales que trabajan en el sector salud.

[Climate change and infectious diseases. A novel epidemiological scenario]. / Cambio climático y enfermedades infecciosas. Un nuevo escenario epidemiológico.

For the international scientific community, it is undoubted that planetary temperature is increasing, being projected an average raise of 1.0 degrees C-3.5 degrees C by the year 2100. Forecasted consequences are diverse, most of them adverse for human health, including the establishment of favorable epidemiological scenarios for the emergence and reemergence of infectious diseases. The present article summarizes the available evidence regarding the mechanisms that promote climate change, its environmental effects and its consequences on human health. In order to accomplish this objective, demonstrated changes in the dynamics of zoonotic, vectorial, food and water-borne diseases are described. The position of Chile in the international community is commented, as well as multiple pending challenges, among which outstands the importance of incorporating professionals that work in the health sector to the national debate.

[BICAP tumor probe in the palliative treatment of malignant esophageal stenosis]. / BICAP tumor probe en el tratamiento paliativo de la estenosis esofágicas malignas.

BACKGROUND: BICAP tumor probe is a device that consists in an energy source and olives that deliver bipolar electricity. It can be used for the fulguration of esophageal tumors after endoscopic dilatation. AIM: To report the experience in the treatment of malignant esophageal stenoses using the BICAP tumor probe. PATIENTS AND METHODS: Patients with advanced esophageal tumors in aphagia, that were not candidates for palliative surgery were included in this study. After endoscopic dilatation, the tumor was fulgurated with the BICAP tumor probe. RESULTS: Twenty one patients (nine male, aged 43 to 91 years old) were treated with the device. A mean of 1.3 sessions with BICAP were necessary to obtain tumor permeabilization, which was obtained in all patients. One patient died of pneumonia 15 days after the procedure. All other patients were ingesting liquid or semisolid diets after two months of follow up. Mean survival after the procedure was 3.8 months. CONCLUSIONS: Electrical fulguration of esophageal tumors is a valid therapeutic alternative in aphagic patients.

A phase II study of doxorubicin/paclitaxel plus G-CSF for metastatic breast cancer.

This phase II trial was conducted to evaluate the percentage of objective responses and the toxicity profile of combination doxorubicin (Adriamycin) and paclitaxel (Taxol) with granulocyte colony-stimulating factor as first-line therapy for patients with metastatic breast cancer (MBC) not previously exposed to anthracycline-containing regimens. Patients with measurable, visceral-dominant MBC and a performance status of 0 to 2 were included in the study. Doxorubicin 60 mg/m2 was administered as a short intravenous infusion, followed by paclitaxel 250 mg/m2 as a 3-hour intravenous infusion on day 1. Granulocyte colony-stimulating factor 5 micrograms/kg/d was given prophylactically as a subcutaneous injection from day 2 until granulocyte recovery to > or = 1,500/mm3. Treatment was repeated every 21 days for a maximum of six courses. Dose reductions (to doxorubicin 50 mg/m2 and paclitaxel 175 mg/m2) and/or treatment delay were applied in case of severe toxicity. All 25 women who entered were evaluable for response and toxicity. The main grade 3/4 toxicities observed were leukopenia, thrombocytopenia, and mucositis. Alopecia occurred in all patients. No clinically relevant cardiovascular toxicity was observed. Severe myelosuppression and/or mucositis necessitated dose reductions at courses 2 or 3 in all but one patient. The complete response rate was 28%, and the partial response rate was 52% for an overall objective response rate of 80%. Median progression-free survival for complete responders was 11 months (range, 3 to 24 months), while the progression-free survival was 7+ months (range 2 to 14+ months) for partial responders and 5 months (range, 3 to 9 months) for nonresponders. This combination produces a high objective response rate in women with MBC, but dose reductions were necessary in almost all cases. Toxicity was manageable after dose reduction, allowing patients to be re-treated for two to six courses without life-threatening toxicity or toxic deaths. Unfortunately, the duration of response was limited even among complete responders. Further trials of this combination in patients with MBC should explore improvements in this study regimen.

Comparison of Viscoped and PORON for painful submetatarsal hyperkeratotic lesions.

A clinical study was performed to evaluate the efficacy of the Viscoped Insole as compared with an 1/8-inch PORON medical materials insole in the treatment of lesser submetatarsal hyperkeratotic callosities. Thirty-five patients, ranging in age from 23 through 61 years (average 42 years) were randomly divided into three groups. All three groups initially had debridement of their submetatarsal callosities. In addition to the debridement, the first group (16 patients) wore a Viscoped Insole for 4 weeks. The patients in the second group wore a PORON insole for 4 weeks. The third group did not receive an insole after their debridement and served as the control. There was a significant improvement in the Viscoped group and the PORON group versus the control group (x2 = 40; p < 0.01) as measured by the foot function index. Insole therapy combined with debridement for submetatarsal hyperkeratoses is more effective than debridement alone.

Evaluation of magnetic foil and PPT Insoles in the treatment of heel pain.

The effect of a magnetic foil placed in the PPT/Rx Firm Molded Insole on the relief of heel pain was determined using the foot function index. Nineteen patients wore the PPT/Rx Firm Molded Insoles with the magnetic foil for 4 weeks and 15 patients wore the same PPT/Rx Firm Molded Insole with no magnetic foil for the same time. Approximately 60% of patients in both groups reported improvement. There was also no significant difference in the improvement between the magnetic foil group and the PPT/Rx Firm Molded Insole group in their scores on the post-treatment foot function index. These results suggest that the PPT/Rx Firm Molded Insole alone was effective in treating heel pain after only 4 weeks. The magnetic foil offered no advantage over the plain insole.

Linfoma cutáneo con compromiso pulmonar / Cutaneous lymphoma with pulmonary complication

Paciente varón de 31 años sin patología previa, que comenzó con cuadro de dermatitis, que no respondió a tratamiento esteroidal, generalizándose. Se realizó biopsia de piel informándose linfoma de células T; presentó masas pulmonares que se biopsiaron por broncoscopía en la que también apareció linfoma de células T. Dentro del estudio se confirmó serología positiva a HTLV-I. Se realizó quimioterapia, produciéndose neumotórax por necrosis de masas tumorales, que no se operó. Sobrevive por más de 33 meses con quimioterapia y aún está en control. Se comenta la asociación entre linfoma T e infección con virus HTLV-I y la situación actual en Chile de esta condición

Fracture of the fifth digit. An atypical presentation.

Digital fractures are a common injury in the forefoot. Most fractures, however, do not present relatively free of pain. When they present without pain or with few symptoms, they may be overlooked or misdiagnosed. The following is a case presentation of a patient who presented to Franklin Delano Roosevelt Hospital after trauma to the right fifth toe. The case was atypical in that the patient was asymptomatic despite the recent injury. Rapid conservative intervention by the patient at home, coupled with sensory neuropathy secondary to diabetes, can alter the clinical presentation as witnessed in this case. An appropriate history and physical examination combined with radiographs were essential to an otherwise ordinary clinical presentation.

Melanoma maligno cutâneo no Rio Grande do Sul: estudo de 101 casos / Cutaneous malignant melanoma in Rio Grande do Sul, Brazil: study of 101 cases

Between 1985 and 1989, at the Hospital de Clínicas de Porto Alegre (HCPA), 101 cases of cutaneous malignant melanoma (CMM) were reviewed in order to evaluate the status of the disease at diagnosis. The cases were obtained from the records of the pathology service of the HCPA. Nodular Melanoma (ND) was the most frequent type (36.6). In males, the predominant site was in the head, neck and trunk while in females it was in the lower limbs Clark level V was found in 35.6 of the cases. In 23.8, the tumor was larger than 4mm in depth according to Breslow classification. These results clearly demonstrate that the diagnosis of CMM is established in later stages of the disease.

[Cutaneous malignant melanoma in Rio Grande do Sul, Brazil: study of 101 cases]. / Melanoma maligno cutâneo no Rio Grande do Sul: estudo de 101 casos.

Between 1985 and 1989, at the Hospital de Clínicas de Porto Alegre (HCPA), 101 cases of cutaneous malignant melanoma (CMM) were reviewed in order to evaluate the status of the disease at diagnosis. The cases were obtained from the records of the pathology service of the HCPA. Nodular Melanoma (ND) was the most frequent type (36.6%). In males, the predominant site was in the head, neck and trunk while in females it was in the lower limbs Clark level V was found in 35.6% of the cases. In 23.8%, the tumor was larger than 4mm in depth according to Breslow classification. These results clearly demonstrate that the diagnosis of CMM is established in later stages of the disease.

Filtration sizes of human immunodeficiency virus type 1 and surrogate viruses used to test barrier materials.

Filters with well-defined holes were used to determine the effective diameters in buffer of human immunodeficiency virus type 1, herpes simplex virus type 1, and four bacteriophages (phi X174, T7, PRD1, and phi 6), which may serve as surrogate viruses for testing barrier materials. Bacteriophages phi 6 and PRD1 most closely model human immunodeficiency virus type 1 in filtration size.

Important factors for testing barrier materials with surrogate viruses.

This study evaluated bacteriophages phi X174, T7, PRD1, and phi 6 as possible surrogates for pathogenic human viruses to challenge barrier materials and demonstrated some important factors for their use. Chemical incompatibility with test material was demonstrated when lipid-enveloped phi 6 was inactivated by an aqueous eluate of vinyl gloves, but 0.5% calf serum protected phi 6 from the eluate. Low concentrations (2%) of calf serum also prevented the exaggerated binding of the bacteriophages to filters. Recovery of viruses from surfaces decreased with increasing time before recovery. Penetration through punctures displayed different types of kinetics. The combined data indicate that (i) some bacteriophages may serve as surrogate viruses, (ii) experimental conditions determine whether a particular virus is appropriate as a challenge, and (iii) phi X174 is an excellent choice as a surrogate virus to test barrier materials. The data further indicate that before barrier materials are challenged with viruses, adequate tests should be performed to ensure that the virus is compatible with the test material and test conditions, so that meaningful data will result.

Chile: perspectives in school health.

The leading health problems of children and adolescents in Chile is reviewed. The Chilean educational system and how the system addresses its principal health problems are described. A school health program is described as well as other educational programs designed and developed by nongovernmental institutions which have a smaller coverage. Current research studies regarding growth and development, child morbidity, nutritional level, and mental health studies are reviewed. In addition, principal challenges that include developing more efficient ways of referring children, enriching the curriculum and teacher training, assigning school hours for health teachers, and enlarging coverage of the health care evaluation programs are outlined. Of special importance is developing prevention programs for parents and children using school and community leaders to prevent health problems in areas such as human sexuality education, decision-making, social abilities, and alcohol and drug abuse. Main efforts should be directed toward low-income families and children to improve life conditions.

PIP: The leading health problems of children and adolescents in Chile is reviewed. The Chilean educational system and how the system addresses its principal health problems are described. A school health program is described as well as other educational programs designed and developed by nongovernmental institutions which have a smaller coverage. Current research studies regarding growth and development, child morbidity, nutritional level, and mental health studies are reviewed. In addition, principal challenges that include developing more efficient ways of referring children, enriching the curriculum and teacher training, assigning school hours for health teachers, and enlarging coverage of the health care evaluation programs are outlined. Of special importance is developing prevention programs for parents and children using school and community leaders to prevent health problems in areas such as human sexuality education, decision making, social abilities, and alcohol and drug abuse. Main effort should be directed toward low-income families and children to improve life conditions. The Chilean school health program includes health screenings for high-risk schools. These are defined as those located in low socioeconomic communities. There are medical clinics for problems detected by the school health evaluation through anthropometric tests. If necessary, the student is hospitalized. Immunization is carried out in every Chilean elementary school (grades 1-8). Local health programs consist of health promotion programs, disease prevention programs, and mental health programs (including substance addiction). The greatest challenge now is to implement local, regional, and national policies, adapting the program to regional differences; creating new educational areas, and providing human resources and materials.