Potential angiogenic biomarkers in hereditary hemorrhagic telangiectasia and other vascular diseases.

Biomarkers are new tools framed in precision and personalized medicine. Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic vascular disease with disturbances in the angiogenic pathways. Descriptive evidence supports that some angiogenesis-related molecules are differently detected in HHT patients compared to healthy subjects. These molecules are also related to diagnosis, prognosis, complications and therapy monitoring in other common vascular diseases. Despite the need for improving knowledge before applying them in daily clinical practice, there are good candidates to be considered as potential biomarkers in HHT and other vascular diseases. In the present review, the authors aim to summarize and discuss current evidence regarding the main putative angiogenic biomarkers by describing the biological role of each biomarker, the evidence related to HHT and their potential use in this and other common vascular diseases from a clinical point-of-view.

Translational medicine in hereditary hemorrhagic telangiectasia.

Scientific community have gained lots of new insights in the genetic and biochemical background of different conditions, rare diseases included, settling the basis for preclinical models that are helping to identify new biomarkers and therapeutic targets. Translational Medicine (TM) is an interdisciplinary area of biomedicine with an essential role in bench-to-bedside transition enhancement, generating a circular flow of knowledge transference between research environment and clinical setting, always centered in patient needs. Here, we present different tools used in TM and an overview of what is being done related to hereditary hemorrhagic telangiectasia (HHT), as a disease's model. This work is focused on how this combination of basic and clinical research impacts in HHT patient's daily clinical management and also looking into the future. Further randomized clinical trials with HHT patients should assess the findings of this bench-to-bedside transition. The benefits of this basic and clinical research combination, may not only be important for HHT patients but for patients with other vascular diseases sharing angiogenic disturbances.

Adrenomedullin as a potential biomarker involved in patients with hereditary hemorrhagic telangiectasia.

BACKGROUND: Adrenomedullin (AM) is a vasoactive peptide mostly secreted by endothelial cells with an important role in preserving endothelial integrity.  The relationship between AM and hereditary hemorrhagic telangiectasia (HHT) is unknown. We aimed to compare the serum levels and tissue expression of AM between HHT patients and controls. METHODS: Serum AM levels were measured by radioimmunoassay and compared between control and HHT groups. AM levels were also compared among HHT subgroups according to clinical characteristics. The single nucleotide polymorphism (SNP) rs4910118 was assessed by restriction analysis and sequencing. AM immunohistochemistry was performed on biopsies of cutaneous telangiectasia from eight HHT patients and on the healthy skin from five patients in the control group. RESULTS: Forty-five HHT patients and 50 healthy controls were included, mean age (SD) was 50.7 (14.9) years and 46.4 (9.9) years (p = 0.102), respectively. HHT patients were mostly female (60% vs 38%, p = 0.032). Median [Q1-Q3] serum AM levels were 68.3 [58.1-80.6] pg/mL in the HHT group and 47.7 [43.2-53.8] pg/mL in controls (p<0.001), with an optimal AM cut-off according to Youden's J statistic of 55.32 pg/mL (J:0.729). Serum AM levels were similar in the HHT subgroups. No patient with HHT had the SNP rs4910118. AM immunoreactivity was found with high intensity in the abnormal blood vessels of HHT biopsies. CONCLUSIONS: We detected higher AM serum levels and tissue expression in patients with HHT than in healthy controls. The role of AM in HHT, and whether AM may constitute a novel biomarker and therapeutic target, needs further investigation.

Gender differences in hereditary hemorrhagic telangiectasia severity.

BACKGROUND: Gender differences in organ involvement and clinical severity have been poorly described in hereditary hemorrhagic telangiectasia (HHT). The aim of this study was to describe differences in the severity of HHT manifestations according to gender. METHODS: Severity was measured according to Epistaxis Severity Score (ESS), Simple Clinical Scoring Index for hepatic involvement, a general HHT-score, needing for invasive treatment (pulmonary or brain arteriovenous malformations -AVMs- embolization, liver transplantation or Young's surgery) or the presence of adverse outcomes (severe anemia, emergency department -ED- or hospital admissions and mortality). RESULTS: One hundred forty-two (58.7%) women and 100 (41.3%) men were included with a mean age of 48.9 ± 16.6 and 49 ± 16.5 years, respectively. Women presented hepatic manifestations (7.1% vs 0%) and hepatic involvement (59.8% vs 47%), hepatic AVMs (28.2% vs 13%) and bile duct dilatation (4.9% vs 0%) at abdominal CT, and pulmonary AVMs at thoracic CT (35.2% vs 23%) more often than men. The Simple Clinical Scoring Index was higher in women (3.38 ± 1.2 vs 2.03 ± 1.2), and more men were considered at low risk of harboring clinically significant liver disease than women (61% vs 25.3%). These differences were mantained when considering HHT1 and HHT2 patients separetely. Duodenal telangiectasia were more frequent in men than women (21% vs 9.8%). Invasive treatments were more frequently needed in women (28.2% vs 16%) but men needed attention at the ED more often than women (48% vs 28.2%), with no differences in ESS, HHT-score, anemia hospital admissions or mortality. CONCLUSIONS: HHT women showed more severe hepatic involvement than men, also among HHT1 and HHT2 patients. Women had higher prevalence of pulmonary AVMs and needed invasive procedures more frequently, while men needed attention at the ED more often. These data might help physicians to individualize HHT patients follow-up.

Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry.

BACKGROUND: The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD: The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS: 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION: The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.

Characterization of the phone-calls made to a poison center related to household and cosmetics products exposition in pediatrics. / Caracterización de las consultas realizadas a un Centro de Información Toxicológica por productos de aseo y productos cosméticos en niños.

INTRODUCTION: Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population. OBJECTIVE: To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC). PATIENTS AND METHOD: Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'. RESULTS: 3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%). CONCLUSIONS: Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.

Caracterización de las consultas realizadas a un Centro de Información Toxicológica por productos de aseo y productos cosméticos en niños / Characterization of the phone-calls made to a poison center related to household and cosmetics products exposition in pediatrics

INTRODUCCIÓN: Los productos de aseo y cosméticos son necesarios en el diario vivir y ampliamente utilizados por la población. Sin embargo, su uso puede no estar exento de riesgos, especialmente cuando no se utilizan o almacenan según lo recomendado. Es importante caracterizar las exposiciones, ya que eso es útil para implementar estrategias para reducir la morbilidad, mortalidad y costos asociados, especialmente en la población infantil. OBJETIVO: Caracterizar los reportes asociados a exposiciones a productos de aseo y productos cosméticos en pacientes menores de 12 años reportados al Centro de Información Toxicológica de la Universidad Católica de Chile (CITUC). PACIENTES Y MÉTODO: Estudio descriptivo transversal de llamados telefónicos reportados a CITUC durante el año 2016. Se analizaron las variables: edad, sexo, agente, interlocutor, localización del interlocutor e inciden te, circunstancia de exposición, vía(s) de exposición, sintomatología, y severidad, mediante fichas de registro manual y desde el software de registro electrónico denominado "INTOX Data Manage ment System" de la OMS. RESULTADOS: Cumplieron criterios de inclusión 3.415 casos. Los menores de 5 años representaron el 91% de las exposiciones y el 58,5% correspondió al sexo masculino. Un 99,4% correspondió a exposiciones accidentales y el 98,6% ocurrieron en el hogar. El 68,3% no presentó síntomas, tras la exposición. Las llamadas fueron realizadas por familiares (57%) y personal de salud (42%). Los 4 agentes con mayor incidencia fueron cloro doméstico (27,6%), limpiadores y lustres de pisos (13,1%), lavalozas (7,9%) y perfumes/colonias (5,8%). La principal vía de exposición fue digestiva (89,4%). CONCLUSIONES: Los productos de aseo y cosméticos son causas comunes de exposiciones especialmente en menores de 5 años. Si bien son productos de baja mortalidad y morbilidad, es importante educar a la población para prevenir posibles intoxicaciones en la población infantil.

INTRODUCTION: Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population. OBJECTIVE: To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC). PATIENTS AND METHOD: Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'. RESULTS: 3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%). CONCLUSIONS: Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.

Anthracycline-based triplets do not improve the efficacy of platinum-fluoropyrimidine doublets in first-line treatment of advanced gastric cancer: real-world data from the AGAMEMON National Cancer Registry.

BACKGROUND: Although anthracycline-based triplets are one of the most widely used schedules to treat advanced gastric cancer (AGC), the benefit of including epirubicin in these therapeutic combinations remains unknown. This study aims to evaluate both the efficacy and tolerance of triplets with epirubicin vs. doublets with platinum-fluoropyrimidine in a national AGC registry. METHODS: Patients with AGC treated with polychemotherapy without trastuzumab at 28 hospitals in Spain between 2008 and 2016 were included. The effect of anthracycline-based triplets against doublets was evaluated by propensity score matching (PSM) and Cox proportional hazards (PH) regression. RESULT: A total of 1002 patients were included (doublets, n = 653; anthracycline-based triplets, n = 349). The multivariable Cox PH regression failed to detect significantly increased OS in favor of triplets with anthracyclines: HR 0.90 (95% CI, 0.78-1.05), p = 0.20035. After PSM, the sample contained 325 pairs with similar baseline characteristics. This method was also unable to reveal an increase in OS: 10.5 (95% CI, 9.7-12.3) vs. 9.9 (95% CI, 9.2-11.4) months, HR 0.91 (CI 95%, 0.76-1.083), and (log-rank test, p = 0.226). Response rates (42.1 vs. 33.1%, p = 0.12) and PFS (HR 0.95, CI 95%, 0.80-1.13, log-rank test, p = 0.873) were not significantly higher with epirubicin-based regimens. The triplets were associated with greater grade 3-4 hematological toxicity, and increased hospitalization due to toxicity by 68%. The addition of epirubicin is viable, but 23.7% discontinued treatment because of adverse effects or patient decision. CONCLUSION: Anthracyclines added to platinum-fluoropyrimidine doublets did not improve the response rate or survival outcomes in patients with AGC but entailed greater toxicity.

Peeling químico, una herramienta útil en la consulta / Chemical Peeling: A Useful Tool in the Office

Las exfoliaciones químicas (más conocidas como peelings químicos) son tratamientos utilizados frecuentemente en dermatología estética. En concreto el peeling con ácido tricloroacético se ha utilizado desde hace años y una de sus principales limitaciones clásicamente era sus efectos secundarios. Presentamos una revisión práctica de las características, mecanismos de acción, indicaciones y complicaciones de los peelings en general, tanto los superficiales como el peeling con ácido tricloroacético (AU)

Chemical peeling is a common treatment in cosmetic dermatology. A peel that has been used for many years is trichloroacetic acid. Its adverse effects have for a long time been a major limitation. We present a practical review of the characteristics, mechanisms of action, indications, and complications of superficial chemical peels and of peeling with trichloroacetic acid (AU)

Chemical Peeling: A Useful Tool in the Office. / Peeling químico, una herramienta útil en la consulta.

Chemical peeling is a common treatment in cosmetic dermatology. A peel that has been used for many years is trichloroacetic acid. Its adverse effects have for a long time been a major limitation. We present a practical review of the characteristics, mechanisms of action, indications, and complications of superficial chemical peels and of peeling with trichloroacetic acid.

Riesgo de mortalidad en pacientes con diabetes mellitus tipo 2 hospitalizados por insuficiencia cardiaca aguda / Mortality in type 2 diabetes patients admitted because of acute heart failure

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Intoxicaciones veterinarias en Chile reportadas al Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile (CITUC) / Chile veterinary poisonings reported to the Poison Information Center at the Pontificia Universidad Catolica de Chile (CITUC)

Las intoxicaciones en animales son una problemática a nivel mundial, constituyen una causa habitual de consultas veterinarias y muertes. En Chile existe escasa información sobre el tema y se hace necesario investigar sobre agentes tóxicos involucrados y especies expuestas. En este estudio se describen las exposiciones a diferentes agentes potencialmente tóxicos por parte de animales registradas por el CITUC durante el período 2006-2013. Las variables analizadas fueron especie, agente, vía de exposición, interlocutor y lugar de procedencia del llamado de acuerdo al formato de la O.M.S. Se analizaron 3.261 llamados, predominando las exposiciones en perros (83,6%), siendo el principal interlocutor el dueño del animal (74,3%). El principal agente correspondió a plaguicidas (63,1%), destacándose entre ellos los rodenticidas (58,4%). Los llamados se realizaron principalmente desde el hogar (74,6%), seguido por clínicas veterinarias (22,8%). La probabilidad de exposición por plaguicidas en perros fue 1,3 veces superior que en otras especies de animales (IC95%: 1,1-1,6). Al analizar las intoxicaciones por rodenticidas se observó que el 91,8% de éstas se produjo en perros y que el riesgo de exposición en esta especie por esta familia de plaguicidas fue 2,3 veces superior (IC 95%: 1,4-3,7) con respecto a otros animales. En conclusión, la mayoría de estas exposiciones reportadas ocurrió en animales de compañía. El conocimiento sobre el peligro potencial de los tóxicos presentes en el hogar por parte de los responsables de la tenencia de mascotas, juega un papel fundamental en la prevención de intoxicaciones en especies animales (AU)

Poisonings in animals are a problem worldwide, are a common cause of veterinary visits and deaths. In Chile there is little information on the subject and we need to investigate toxic agents involved and exposed species. In this study different exposures to potentially toxic agents registered by the CITUC during the period 2006-2013 animals are described. The variables analyzed were kind, agent, route of exposure, interlocutor and place of origin of the call according to the format called WHO 3261 were analyzed, predominantly exhibits dogs (83.6%), the main contact the owner of animal (74.3%). The main agent corresponded to pesticides (63.1%), especially including rodenticides (58.4%). Calls were made mainly from home (74.6%), followed by veterinary clinics (22.8%). The probability of pesticide exposure in dogs was 1.3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. followed by veterinary clinics (22.8%). The probability of pesticide exposure in dogs was 1.3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. followed by veterinary clinics (22.8%). The probability of pesticide exposure in dogs was 1.3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. 3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. 3 times higher than in other species of animals (95% CI: 1.1-1.6). When analyzing rodenticide poisoning it was observed that 91.8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3 , 7) relative to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. 8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3.7) compared to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals. 8% of these occurred in dogs and the risk of exposure in this species by this family of pesticides was 2.3 times higher (95% CI: 1.4-3.7) compared to other animals. In conclusion, most of these reported exposures occurred in pets. Knowledge about the potential danger of toxic present in the home by responsible pet ownership plays a key role in preventing poisoning in animals

Cuantificación de bacterias relacionadas con la caries dental en saliva de adultos y adultos mayores / Quantification of caries-associated bacteria from saliva of adults and older adults

Introducción: Se considera que Streptococcus mutans (S. mutans) y Lactobacillus spp. se asocian con la caries. Otras especies del biofilm oral, como Streptococcus sanguinis (S. sanguinis) han sido sindicadas como protectoras, pero principalmente en niños. Existe escasa evidencia sobre el nivel de estas bacterias en adultos mayores. Objetivo: Determinar si existen diferencias en los recuentos microbianos de tres especies relacionadas con la caries en pacientes adultos y adultos mayores. Materiales y Métodos: Una muestra de pacientes por conveniencia compuesta de 63 pacientes (18 a 79 años) proporcionó saliva estimulada con la que se sembraron placas de agar MSB, MM10 SB y Agar Rogosa para el cultivo de S. mutans, S. sanguinis y Lactobacillus spp., respectivamente. Los recuentos bacterianos fueron expresados como UFC/mL. Resultados: Los recuentos de S. mutans y Lactobacillus spp. no mostraron variaciones relacionadas con la edad (p>0.05). Los adultos mostraron mayores recuentos de S. sanguinis que los adultos mayores, 3.7 x 105 +/- 3.8 x 105 UFC/mL y 5.9 x 104 +/- 9.4 x 104 UFC/mL, respectivamente (p<0.05). Conclusiones: La edad no parece afectar los niveles de especies tradicionalmente consideradas como cariogénicas. Estos resultados sugieren que la edad puede relacionarse con los patrones de colonización de S. sanguinis en el biofilm oral.

Introduction: Streptococcus mutans (S. mutans) and Lactobacillus spp. have been traditionally associated with caries, regardless of the subject’s age. Other oral biofilm species have been linked as caries protective, including Streptococcus sanguinis (S. sanguinis), but mainly in children. Scarce evidence exists on the levels of these bacteria in older adults. Aim: To determine whether there are differences in the microbial counts of three caries-associated bacterial species in adults and older adults. Methodology: A convenience sample of sixty three patients, aged 18 to 79 years, participated in the study. Stimulated saliva samples were obtained and in MSB, MM10 and Rogosa agar plates for the culture of S. mutans, S. sanguinis and Lactobacillus spp., respectively. Bacterial counts were obtained by microscopic observation (10x) of the colonies and expressed in CFU/mL. Results: Bacterial counts of S. mutans and Lactobacillus spp. did not reveal age-related differences (p>0.05). Adults showed higher S. sanguinis counts than older adults with 3.7 x 105 +/- 3.8 x 105 CFU/mL and 5.9 x 104 +/- 9.4 x 104 CFU/mL, respectively (p<0.05). Conclusions: Age does not seem to affect the levels of bacterial species traditionally associated with caries. The results suggest that age may be related to colonization patterns of S. sanguinis in the oral biofilm.

Caracterización del perfil epidemiológico de las llamadas alCentro de Información Toxicológica de la Universidad Católica (CITUC), en el año 2010 / Characterization of the epidemiological profile of calls received at the Poison Information Center of the Catholic University (CITUC), in 2010

Objetivo: Describir y caracterizar el perfil epidemiológico de las llamadas recibidas en el año 2010 correspondiente a exposiciones, por el Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile. Método: Se realizó un estudio retrospectivo y descriptivo de las llamadas registradas por el CITUC durante el año 2010. Se analizaron los siguientes datos: número total de llamadas, lugar de la llamada, circunstancia de la exposición, tipo y número de los agentes involucrados, vías de exposición, tiempo desde la exposición, género y edad de los pacientes. Resultados: Se registraron 29.592 llamadas. 45,2 por ciento de las consultas provenían del hogar y 53,2 por ciento de instalaciones médicas. 69,3 por ciento fueron exposiciones accidentales y 27,6 por ciento intencionales. Los medicamentos se presentaron como agente causal de una exposición en 58,4 por ciento de las llamadas, seguidos por los productos de uso doméstico (18,7 por ciento) y plaguicidas (5,8 por ciento). La ingestión fue la vía de exposición que predominó en un 79,3 por ciento del total de casos. 41,0 por ciento del total de las llamadas, se realizaron dentro de la primera hora post-exposición. Las exposiciones en niños menores de 14 años correspondieron a 51,6 por ciento de las llamadas. Conclusiones: Los medicamentos constituyen el principal agente involucrado en intoxicaciones. La principal vía de exposición es la ingesta y el principal grupo de población afectado son los niños menores de 14 años,. Estos indicadores muestran la necesidad imperante de desarrollar campañas de prevención e información avaladas por el Ministerio de Salud, respecto al correcto uso de los medicamentos, como también la introducción del envase resistente ala manipulación de los niños y la educación de la población.

Objective: To describe and to characterize the epidemiologoc profile of the entering pone calls in 2010 belonging to exposures by the Centro de Información Toxicológica de la Pontificia Universidad Católica de Chile. Method: A retrospective and descriptive study of pone calls registered by the CITUC has been made during 2010. The following has been analyzed: total pone calls number, place of the call, exposure circumstances, kind and number ofagents involved, exposure way, time from exposure, gender and age of the patients. Outcomes: 29.592 phone calls were registered. 45,2 percent of the questions came from home and 53,2 percent from medical institutions. 69,3 percent were non intented exposures and 27,6 percent were intented. The drugs were the causal agent of exposures in 58,4 percent of the phone calls, followed by cleaning use products (18,7 percent) and insecticides (5,8 percent). Swallowing was the predominant exposure way with 79,3 percent of the total. 41 percent of total of phone calls, were made in the first hour after exposure. The children under 14 years exposure cases, were were 51,6 percent of total phone calls. Conclusions: Medical drugs are the principal involved agent in intoxications. The main way of exposition is swallowing and the major population group involved is children under 14 years. These indicators shows the need of developing prevention and information campaigns supported by Secretary of Health, oriented to right use of drugs, as well as the use of safety drug boxes for children and population education.

In vitro activity of telithromycin, quinupristin/dalfopristin, linezolid and comparator antimicrobial agents against Staphylococcus aureus clinical isolates.

We have studied the prevalence of the different macrolide, lincosamide, streptograminB (MLS(B)) phenotypes among clinical Staphylococcus aureus isolates erythromycin- and/or oxacillin-resistant; and also the activity of other antimicrobial agents including telithromycin, quinupristin/dalfopristin, linezolid, aminoglycosides, chloramphenicol and vancomycin. We found that 64.86% of S. aureus were oxacillin-resistant. While the most prevalent MLS(B) phenotype among methicillin-resistant S. aureus (MRSA) was constitutive MLS(B) (cMLS) (83%), among methicillin-susceptible S. aureus (MSSA) it was inducible MLS(B) (iMLS(B)) (90%). Kanamycin resistance was more frequent than resistance to other aminoglycosides, being 100% for MRSA. Telithromycin was only active against iMLS(B), MS and erythromycin-susceptible isolates, although resistance rates were found among iMLS(B) MSSA (2.78%). Quinupristin/dalfopristin showed greater activity, with resistance rates of 2.5% for MRSA and 1.53% for MSSA. Both vancomycin and linezolid were fully active against all the isolates tested, with the highest MIC value being 2 microg/ml and 4 microg/ml, respectively. Among MRSA strains, 81.67% displayed resistance to five or more antimicrobials. This multiresistance was more frequently found among cMLS(B) strains (96.38% MRSA resistant to 6-9 agents).

Epidemiological study of resistance to nalidixic acid and other antibiotics in clinical Yersinia enterocolitica O:3 isolates.

Forty-six Yersinia enterocolitica O:3 clinical isolates resistant to nalidixic acid were studied. The use of molecular typing techniques, other indicators of resistance patterns, the plasmid profile, and the presence of genes that encode aminoglycoside-modifying enzyme production suggested to us a clonal dissemination of the studied strains.

Nuevos conceptos acerca del síndrome hemolítico urémico / New concepts about hemolytic-uremic syndrome

El síndrome hemolítico urémico (SHU) es heterogéneo en su etiología, fisiopatología, tratamiento y diagnóstico. En esta presentación se analizan algunos aspectos de su epidemiología, clínica e inmunopatología. La distribución del SHU es universal, pero en Argentina, sur de Europa, Sudáfrica y oeste de USA se detecta con mayor frecuencia que en el resto de los países. Los estudios inmunopatológicos muestran lesiones angiopáticas trombóticas consistentes en alteración generalizada del epitelio capilar y arteriolar. Entre los factores que aparentemente participan en la génesis del síndrome se analizan la disminución de los niveles de prostaglandina PGT2, del factor de von Willebrand y las toxinas de origen microbiano. La diálisis es una de las herramientas más útiles en el manejo del SHU. A pesar de los actuales conocimientos, todavía se requiere más investigación para conocer los mecanismos íntimos del síndrome

Asfixia por inmersión / Immersion by asphyxia

Se analizan 19 pacientes ingresados con el diagnóstico de asfixia por inmersión entre el 31 de diciembre de 1983 y el 31 de diciembre de 1987 con una edad promedio de 2 años 3 meses. Al momento del rescate todos los niños tenían cianosis y 16 apnea, pero sólo 11 recibieron algún tipo de reanimación, siendo ésta adecuada sólo en 4. Siete pacientes ingresaron en etapa A de Coon, 2 en etapa B y 10 en etapa C. En 6 casos se efectuó monitoría de la presión intracraneana, demostrándose hipertensión en dos, que fallecieron. Cinco pacientes desarrollaron edema pulmonar no cardiogénico y 4 presentaron hipotensión arterial acentuada en las primeras 24 horas, requiriendo fluidoterapia, coloides y medicamentos inotrópicos. Cuatro pacientes fallecieron, todos estaban en etapa C al ingreso. Sólo un paciente quedó con secuelas neurológicas definitivas. En las primeras horas siguientes a la reanimación, las principales complicaciones fueron la inestabilidad hemodinámica, los trastornos respiratorios y los derivados de la encefalopatía hipóxica. El aumento de la PIC no fue un problema precoz, cuando se presentó lo hizo en forma tardía, 24 a 48 horas después de la inmersión. Se subraya la necesidad de fomentar la prevención, mejorar los programas de transporte y educación de técnicas de reanimación básica

[Asphyxia by immersion]. / Asfixia por inmersión.

Nineteen childhood near drowning cases admitted to a private general hospital from December 31, 1983 through out December 1987 at a mean age of 2 years 3 months are discussed. All patients had diagnosis when first found by relatives, 16 were apneic and only 11 received some kind of resuscitation which complied with accepted standards in 4 of them. Seven cases were admitted in stage A of Conn, two in stage B and ten in stage C. In six children in stage C intracranial pressure (ICP) monitoring was done and ICP was increased in two that died. Five patients developed clinical and radiological evidence of non cardiogenic pulmonary edema and 4 had hypotension sometime along the first 24 hours, requiring fluid therapy and inotropic drugs. Four patients died, all of them were in stage C when admitted. One child shows severe brain damage four years after discharge. The main complications after resuscitation were hemodynamic instability, pulmonary problems and hypoxic encephalopathy. High ICP was not important in the first hours and when it rose it did so 24 to 48 hours after admission. The need for an active role in prevention, improved resuscitation and transport, is stressed.