[In vitro susceptibility of Chilean Cryptococcus neoformans strains of clinical source]. / Sensibilidad in vitro de cepas chilenas de Cryptococcus neoformans de origen clínico.

BACKGROUND: Cryptococcus yeast infections primarily affect immunocompromised patients. There have been few susceptibility studies conducted for this genus in Chile. AIMS: To determine the in vitro susceptibility to commonly used antifungals and evaluate the concordance between susceptibility determined by microdilution in broth and commercially available strips. METHODS: Descriptive study of 21 Cryptococcus strains, isolated from cerebrospinal fluid and blood. The MIC50 and MIC90 for fluconazole, voriconazole and amphotericin B was determined by broth microdilution (Sensititre Yeast One®) and by commercial drug sensitivity strips (MIC Test Strips). RESULTS: All strains corresponded to C. neoformans. The ranges of MIC50 and MIC90 for each antifungal studied were wide by both methods. The essential agreement between Sensititre Yeast One test and strips was 24, 62 and 29% for fluconazole, voriconazole and amphotericin B, respectively. CONCLUSIONS: The Sensititre Yeast One test and MIC Test Strips exhibited poor essential concordance, especially for fluconazole and amphotericin B.

Sensibilidad in vitro de cepas chilenas de Cryptococcus neoformans de origen clínico / In vitro susceptibility of Chilean Cryptococcus neoformans strains of clinical source

Resumen Introducción: Las infecciones por levaduras del género Cryptococcus afectan principalmente a pacientes con déficit de la inmunidad mediada por células. Han sido escasos los estudios de sensibilidad realizados para este género en Chile. Objetivos: Determinar la sensibilidad in vitro de Cryptococcus sp a antifúngicos de uso habitual y evaluar la concordancia esencial entre sensibilidad determinada por microdilución en caldo y por difusión en agar con tiras comerciales. Materiales y Método: Estudio descriptivo de 21 cepas aisladas desde liquido céfalo-raquídeo y sangre. Las CIM50 y CIM90 para fluconazol, voriconazol y anfotericina B se determinaron por microdilución en caldo (Sensititre Yeast One®) y por difusión en agar con tiras comerciales (MIC Test Strips). Resultados: Todas las cepas correspondieron a C. neoformans. Los rangos de CIM50 y CIM90 para cada antifúngico estudiado fueron amplios por ambos métodos. La concordancia esencial entre microdilución y difusión en agar con tiras comerciales fue de 24, 62 y 29% para fluconazol, voriconazol y anfotericina B, respectivamente. Conclusiones: La prueba de Sensititre Yeast One® y la de difusión en agar con tiras comerciales, MIC Test Strips, tienen una pobre concordancia esencial para fluconazol y anfotericina B.

Abstract Background: Cryptococcus yeast infections primarily affect immunocompromised patients. There have been few susceptibility studies conducted for this genus in Chile. Aims: To determine the in vitro susceptibility to commonly used antifungals and evaluate the concordance between susceptibility determined by microdilution in broth and commercially available strips. Methods: Descriptive study of 21 Cryptococcus strains, isolated from cerebrospinal fluid and blood. The MIC50 and MIC90 for fluconazole, voriconazole and amphotericin B was determined by broth microdilution (Sensititre Yeast One®) and by commercial drug sensitivity strips (MIC Test Strips). Results: All strains corresponded to C. neoformans. The ranges of MIC50 and MIC90 for each antifungal studied were wide by both methods. The essential agreement between Sensititre Yeast One test and strips was 24, 62 and 29% for fluconazole, voriconazole and amphotericin B, respectively. Conclusions: The Sensititre Yeast One test and MIC Test Strips exhibited poor essential concordance, especially for fluconazole and amphotericin B.

[Ringworm of Trichophyton tonsurans outbreak in a basic school in Valparaíso, Chile]. / Brote de tiña por Trichophyton tonsurans en una escuela básica de Valparaíso, Chile.

BACKGROUND: Ringworm are skin and its annexes infections. Trichophyton tonsurans is an emergent anthropophilic fungus that might cause outbreaks. AIM: To describe a ringworm outbreak by T tonsurans in an elementary school in Valparaíso, Chile. METHODS: A descriptive study was run between June and August, 2018. Students and his closest relatives in contact with them who were clinically diagnosed with ringworm have been considered a case. Mycological studies of samples had been carried out through morphophysiology tests. Data are shown in numbers and percentages. RESULTS: There were 18 cases, 16 kids (15 from kindergarten) and 2 adults. Attack rate was 68% in kindergarten. Nine cases were boys with average age of 6 years old. For 14 cases their nationality was Chilean and in 1 case Haitian. First case was a Chilean boy, and primary case was a Haitian boy. The most frequent location was face. Ten cases yielded positive cultures for T tonsurans. Most of the patients needed terbinafine treatment after a therapeutic failure performed with clotrimazole. CONCLUSION: T. tonsurans outbreak ocurred mainly in kindergarten male. The most frequent location was face. Most of the patients needed terbinafine treatment after a therapeutic failure with clotrimazole.

Brote de tiña por Trichophyton tonsurans en una escuela básica de Valparaíso, Chile / Ringworm of Trichophyton tonsurans outbreak in a basic school in Valparaíso, Chile

Resumen Introducción: Las tiñas son infecciones que afectan la piel y anexos. Trichophyton tonsurans es un hongo antropofílico emergente que puede provocar brotes. Objetivo: Describir un brote de tiña por T. tonsurans en una escuela de Valparaíso. Materiales y Método: Estudio descriptivo realizado entre junio-agosto de 2018. Se consideró caso a todo alumno de la escuela y a familiares directos en contacto con ellos, con diagnóstico clínico de tiña. El estudio micológico de las muestras tomadas se realizó a través de pruebas morfo-fisiológicas. Los datos se expresaron en números y porcentajes. Resultados: Hubo 18 casos, 16 niños (15 del kindergarten) y dos adultos. Tasa de ataque en kindergarten fue de 68%. Nueve casos fueron varones con promedio de edad de 6 años. Catorce de nacionalidad chilena y una haitiana. El caso índice fue un niño chileno y el primario el niño haitiano. La localización más frecuente fue en el rostro. Diez casos tuvieron cultivo con desarrollo de T. tonsurans. La mayoría requirió tratamiento con terbinafina por fracaso terapéutico con clotrimazol. Conclusiones: El brote por T. tonsurans ocurrió principalmente en varones del kindergarten. La principal localización fue en el rostro. La mayoría de los casos requirió terbinafina como tratamiento por fracaso terapéutico con clotrimazol.

Background: Ringworm are skin and its annexes infections. Trichophyton tonsurans is an emergent anthropophilic fungus that might cause outbreaks. Aim: To describe a ringworm outbreak by T tonsurans in an elementary school in Valparaíso, Chile. Methods: A descriptive study was run between June and August, 2018. Students and his closest relatives in contact with them who were clinically diagnosed with ringworm have been considered a case. Mycological studies of samples had been carried out through morphophysiology tests. Data are shown in numbers and percentages. Results: There were 18 cases, 16 kids (15 from kindergarten) and 2 adults. Attack rate was 68% in kindergarten. Nine cases were boys with average age of 6 years old. For 14 cases their nationality was Chilean and in 1 case Haitian. First case was a Chilean boy, and primary case was a Haitian boy. The most frequent location was face. Ten cases yielded positive cultures for T tonsurans. Most of the patients needed terbinafine treatment after a therapeutic failure performed with clotrimazole. Conclusion: T. tonsurans outbreak ocurred mainly in kindergarten male. The most frequent location was face. Most of the patients needed terbinafine treatment after a therapeutic failure with clotrimazole.

Aspergilosis pulmonar invasora en pacientes reumatológicos: presentación de dos casos / Invasive pulmonary aspergillosis in rheumatological patients: presentation of two cases

La aspergilosis pulmonar invasora (API) es una infección causada por hongos del género Aspergillus que afecta principalmente a pacientes inmunocomprometidos y corresponde a la forma más grave de aspergilosis. Se asocia a una alta morbi-mortalidad, siendo fundamental un diagnóstico y tratamiento oportuno. Las manifestaciones clínicas son inespecíficas, por lo que un estudio adecuado es importante para el diagnóstico, principalmente en pacientes con factores de riesgo poco habituales. En la actualidad se han establecido categorías diagnósticas que consideran factores del hospedero, laboratorio micológico tradicional y biomarcadores como galactomanano. Éstos, junto a la mejor comprensión e interpretación de las imágenes tomográficas permiten ofrecer un manejo adecuado. En este artículo, se presentan dos casos clínicos de API en pacientes reumatológicos, y se discute la utilidad de los métodos diagnósticos.

Invasive pulmonary aspergillosis (IPA) is an infection caused by fungi of the genus Aspergillus that mainly affects immunocompromised patients and corresponds to the most severe form of aspergillosis. It is associated with high morbidity and mortality, and diagnosis and timely treatment are essential. Clinical manifestations are nonspecific, so an adequate study is important for diagnosis, mainly in patients with unusual risk factors. At present, diagnostic categories have been established that consider factors of the host, traditional mycological laboratory and biomarkers such as galactomannan. These, together with the better understanding and interpretation of the tomographic images, allow us to offer an adequate management. In this article, two clinical cases of API in rheumatological patients are presented, and the usefulness of the diagnostic methods is discussed.

Aislamiento de Sporothrix pallida y Trichophyton rubrum en onicomicosis de mano / Isolation of Sporothrix pallida and Trichophyton rubrum in hand onychomycosis

Se presenta un caso de onicomicosis de mano, de la cual se aisló en repetidas ocasiones Sporothrix pallida y Trichophyton rubrum. Se discute sobre los principales agentes de onicomicosis, el rol de los hon- gos ambientales y del aislamiento de S.pallida en este y en otro tipo de muestras.

It reports a case of hand onychomycosis, which was isolated repeatedly Sporothrix pallida and Trichophyton rubrum. We discuss the main agents of onychomycosis, the role of the environmental fungi and S.pallida isolation in this and other samples.

Coinfección pulmonar por Aspergillus fumigatus y Pneumocystis jirovecii en un paciente con VIH-SIDA / Lung coinfection by Aspergillus fumigatus and Pneumocystis jirovecii in an HIV-AIDS patient

Se presenta un caso de coinfección pulmonar por Aspergillus fumigatus y Pneumocystis jirovecii en un paciente con VIH-SIDA. Se diagnosticó con TAC pulmonar, visualización directa con KOH 20 por ciento, tinción de Gomori-Grocott y cultivo del LBA, galactomanano en sangre y de LBA. Se discuten los factores de riesgo, diagnóstico y tratamiento para cada infección.

We report a case of lung coinfection by Aspergillus fumigatus and Pneumocystis jirovecii in a patient with HIV-AIDS. Was diagnosed with lung TAC, direct visualization with KOH 20 percent, Gomori- Grocott staining and culture of BAL, galactomannan in blood and BAL. We discuss risk factors, diagnosis and treatment for each infection.

Micosis pulmonares en pacientes de la Quinta Región: Período 2007-2010 / Frequency of pulmonary mycoses determined by analyzing lung secretion samples

Background: The frequency of pulmonary mycoses has increased in the past few years specially in immunocompromised patients. Aim: To determine the frequency of invasive fungal diseases by analyzing lung secretion samples. Material and Methods: Samples of bronchoalveolar lavage (BAL) tracheal aspiration (TA) and induced sputum (IS) were obtained from patients of five hospitals in the Valparaíso Region for the diagnosis of invasive or non-invasive fungal disease, and pneumocystis (PCP), in the period 2007-2010. Clinical data of patients was obtained reviewing medical records or interviewing attending physicians. The diagnosis considered the clinical condition of the patient (immunocompromised or prior lung damage), computed tomography imaging, direct microscopy and cultures. European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria was used for the diagnosis of invasive fungal diseases. Results: Ninety respiratory samples were received and 39 fungal infections were diagnosed. Eleven were probably invasive, seven were non-invasive and 21 were PCP. All patients with probable invasive disease had neutropenia. Most patients with non-invasive infections had bronchiectasis. Aspergillus fumigatus was the main causing agent in both invasive and non-invasive fungal diseases. Patients with PCP were mostly adults with AIDS and children with leukemia. The total mortality rate of patients with invasive fungal disease was of 73%. No deaths were recorded among patients with non-invasive disease. Among patients with PCP, three of 11 HIV and six of 10 non HIV subjects died. Conclusions: Aspergillus fumigatus predominates both in invasive and non-invasive pulmonary mycoses. The former has a high mortality. PCP occurred mainly in adult patients with HIV-AIDS.

[Superficial mycoses in the city of Valparaiso, Chile: period 2007-2009]. / Micosis superficiales en la ciudad de Valparaíso, Chile: Período 2007-2009.

INTRODUCTION: Superficial mycoses are infections of the keratinous tissue caused by dermatophytes, yeasts and environmental fungi. OBJECTIVES: To identify the species of dermatophytes, yeasts and environmental fungi that cause superficial mycosis and analyze their differences by sex, age and location of the lesion, in patients from the region of Valparaiso, during 2007-2009. MATERIALS AND METHODS: 1004 patients diagnosed with superficial mycoses were studied. All ages and both genera were included. The study was done using direct microscopic examination with 20% KOH and culture of the lesions. Fungi identification was mainly morphophysiological. RESULTS: Of the 1004 patients studied, 609 were women and 87.7% was 15 years old or younger. Toenail onychomycosis was the most frequent lesion (58.1%), followed by tinea pedis and interdigitalis (16.3%). In patients younger than 8 years old, tinea capitis by Microsporum canis was the most common mycoses. Among dermatophytes, Trichophyton rubrum (78.9%) predominated in most locations, followed by Trichophyton mentagrophytes (14.9%) and M. canis (5.4%). Candida spp. (95.4%) prevailed among the yeasts causing onychomycosis. There were 27 cases of toenail onychomycosis caused by environmental fungi, mainly Fusarium. CONCLUSIONS: Our results are consistent with national and international data, where T. rubrum is the predominant agent of dermatomycoses. We report the emergency of agents not described in Chile or Latin America in these infections.

Micosis superficiales en la ciudad de Valparaíso, Chile: Período 2007-2009 / Superficial mycoses in the city of Valparaiso, Chile: Period 2007-2009

Introduction: Superficial mycoses are infections of the keratinous tissue caused by dermatophytes, yeasts and environmental fungi. Objectives: To identify the species of dermatophytes, yeasts and environmental fungi that cause superficial mycosis and analyze their differences by sex, age and location of the lesion, in patients from the region of Valparaiso, during 2007-2009. Materials and Methods: 1004 patients diagnosed with superficial mycoses were studied. All ages and both genera were included. The study was done using direct microscopic examination with 20 percent KOH and culture of the lesions. Fungi identification was mainly morphophysiological. Results: Of the 1004 patients studied, 609 were women and 87.7 percent was 15 years old or younger. Toenail onychomycosis was the most frequent lesion (58.1 percent), followed by tinea pedis and interdigitalis (16.3 percent). In patients younger than 8 years old, tinea capitis by Microsporum canis was the most common mycoses. Among dermatophytes, Trichophyton rubrum (78.9 percent) predominated in most locations, followed by Trichophyton mentagrophytes (14.9 percent) and M. canis (5.4 percent). Candida spp. (95.4 percent) prevailed among the yeasts causing onychomycosis. There were 27 cases of toenail onychomycosis caused by environmental fungi, mainly Fusarium. Conclusions: Our results are consistent with national and international data, where T. rubrum is the predominant agent of dermatomycoses. We report the emergency of agents not described in Chile or Latin America in these infections.

Introducción: Las micosis superficiales son infecciones causadas por dermatofitos, levaduras y hongos ambientales en tejidos queratínicos. Objetivos: Conocer las especies de dermatofitos, levaduras y hongos ambientales que causan micosis superficiales, analizar sus diferencias según sexo, edad y localización en pacientes de la Región de Valparaíso durante el período 2007-2009. Materiales y Métodos: Se estudiaron 1.004 pacientes de todas las edades, con diagnóstico de micosis superficiales. Se realizó examen microscópico directo con KOH al 20 por ciento y cultivos de las lesiones. La identificación de los hongos fue principalmente con morfo-fisiología. Resultados: De 1.004 pacientes evaluados, 609 fueron mujeres y 87,7 por ciento tenían sobre 15 años de edad. La onicomicosis de pie fue la lesión más frecuente (58,1 por ciento), seguida de tinea plantar e interdigital (16,3 por ciento). Bajo 8 años de edad, tinea capitis por Microsporum canis fue la lesión más frecuente. Entre los dermatofitos, Trichophyton rubrum (78,9 por ciento) predominó en la mayoría de las localizaciones, seguido por Trichophyton mentagrophytes (14,9 por ciento) y M. canis (5,4 por ciento). Entre las levaduras predominó Candida spp (95,4 por ciento) como causa de onicomicosis. Hubo 27 casos de onicomicosis de pies por hongos filamentosos ambientales, destacando por frecuencia el género Fusarium. Conclusiones: Los datos presentados coinciden en general con los trabajos nacionales e internacionales, donde T. rubrum predomina en la mayoría de las dermatomicosis. Destaca la aparición de agentes no descritos en Chile ni en Latinoamérica en este tipo de infecciones.

[Invasive fungal disease in patients from five hospitals in the Valparaíso region, Chile: 2004 to 2009]. / Enfermedad fúngica invasora en pacientes de cinco hospitales de la Región de Valparaíso, Chile: 2004 a 2009.

INTRODUCTION: Invasive fungal disease (IFD) is a frequent cause of morbidity and mortality in immuno-compromised patients. These infections are caused mainly by Candida albicans and Aspergillus fumigatus. OBJECTIVES: To describe IFD diagnosed by culture in adults and children from five hospitals in Valparaíso, Chile and to determine the species involved and the in vitro sensitivity oí Candida spp. MATERIAL AND METHODS: Biodemographical data, results of cultures, antifungal treatment and mortality after 30 days, was collected. The fungi were identified by standard methods and the sensitivity of the yeasts was obtained according to the M44-A CLSI document. RESULTS: Fifty one IFD were diagnosed, 13 in patients with haematological malignancies and 10 in immunocompetent patients from the adult ICU. The following fungal species were isolated: 34 yeasts, 15 filamentous fungi and 2 Histoplasma capsulatum. There were 33 proven and 1 probable IFD by yeasts. By filamentous fungi, there were 6 proven and 9 probable IFD, 13 out of 15 isolated species were Aspergillus (A. fumigatus being the most frequent). C. albicans was the most frequent isolated yeast, followed by C. tropicalis and C. parapsilosis. All were sensitive to fluconazol and voriconazol, excepting C. glabrata. The mortality by Candida and by filamentous fungi was 42.42% and 86.66% respectively. CONCLUSIONS: IFD was diagnosed mainly in immunocompromised and adult ICU patients. The mortality rate in IFD by filamentous fungi was higher than Candida group. The main agents involved were Candida albicans and Aspergillus fumigatus. A high sensitivity to fluconazol and voriconazol was found in strains of Candida.

Pitiriasis versicolor por Malassezia pachydermatis: caso clínico / Pityriasis versicolor caused by Malassezia pachydermatis: clinical case

Se presenta un caso clínico de pitiriasis versicolor por M. pachydermatis en una paciente de 11 años de edad, diagnosticado mediante clínica, morfofisiología y biología molecular. Malassezia pachydermatis es parte de la microbiota común de diversos mamíferos domésticos y animales salvajes. En éstos se reconoce como agente causal de dermatitis y otitis externa. En humanos se han descrito escasas infecciones ya sea superficiales como invasoras, lo que puede atribuirse a la difícil transmisión y adaptación a partir de los animales domésticos. Se comentan los aspectos biológicos y epidemiológicos de esta infección zoonótica.

A clinical case of pityriasis versicolor caused by M. pachydermatis in an 11 year old patient which was diagnosed by means of clinic, morphophysiology and molecular biology is presented. Malassezia pachydermatis is part of regular microbiota in several domestic mammals as well as wild animals. It is recognized as the causing agent of dermatitis and external otitis in the latter. As to human beings, superficial infections have rarely been given an invasive character what can be explained by the difficult transmission and adaptation coming from domestic animals. Biological and epidemiological aspects of this zoonotic infection are described.

Anfotericina B deoxicolato: experiencia terapeútica en Criptococosis meningea en pacientes VIH adultos del Hospital Carlos van Buren / Anphotericin B deoxicolate, therapeutic experience in meningeal cryptococcosis in a VIH adult patients of Carlos Van Buren Hospital

La anfotericina B es un antifúngico ampliamente usado en infecciones sistémicas por hongos levaduriformes y filamentosos, entre ellas las meningitis por Cryptococcus neoformans. Sus reacciones adversas pueden ser inmediatas o dosis y tiempo dependiente. En nuestro trabajo en el hospital C. van Buren de Valparaíso, se revisaron 27 fichas de pacientes que cumplieron con los criterios de inclusión (24 hombres y 3 mujeres). El principal síntoma de la meningitis por Crytococcus fue la cefalea (96,3 por ciento). En 25 casos hubo confirmación con tinta china y/o cultivo. Durante el tratamiento con anfotericina B la hipokalemia fue la reacción adversa que se presento con mayor frecuencia (83 por ciento) y la nefrotoxicidad en un 59,1 por ciento. La dosis acumulada administrada fue en promedio 525 mg, suspendiendo generalmente su administración cuando se lograba una mejoría clínica junto a esterilidad del LCR (tinta china y/o cultivo negativo). Un 33,3 por ciento de los pacientes con diagnostico de meningitis por C. neoformans falleció por distintas complicaciones.

Amphotericin B is a antifungal drug widely used in systemic infections by filamentous and levaduriform fungi, as in meningitis by Cryptococcus neoformans. Its adverse reactions can be immediate or dose and time dependent. In our paper, 27 patient files were reviewed in C. van Buren hospital of Valparaíso and all of them met the criteria for inclusion (24 men and 3 women). In 96.3 percent of cases, headaches were the main symptom of meningitis caused by Cryptococcus. Twenty five cases were confirmed by the use of chinese ink and/or by culture. During the treatment with amphotericin B, the most frequent changes were hypokalemia (83 percent) and nefrotoxicity in 59.1 percent. The average of cumulative dose administered was 525 mg and was suspended when a clinical recovery was achieved next to a sterile cefalorraquid liquid (negative to chinese ink and/or culture). 33.3 percent of the patients diagnosed with meningitis by C. neoformans died due to different complications.

Reporte clínico: diagnóstico endoscópico e histológico de Aspergilosis Sinusal no invasiva en paciente inmunocompetente / Clinical report: an endoscopic and histologic diagnosis of a non invasive sinusal aspergillosis in an immunocompetent patient

Se describe un caso basado en un diagnóstico clínico, radiológico, endoscópico e histológico de una sinusitis crónica no invasiva en un paciente femenino de 40 años, con historia de rinorrea purulenta unilateral derecha de varios años de evolución. El TAC mostró velamiento del seno maxilar y calcificaciones con diagnóstico probable de infección micótica, sin embargo, no se solicitaron cultivos micológicos. Se indicó cirugía del seno maxilar mediante antrotomía media bajo endoscopia. El diagnóstico histológico reveló abundantes hifas septadas ramifi-cadas no invasivas de la mucosa sinusal con la presencia de algunas estructuras morfológicas asexuales que orientaron hacia un grupo taxonómico específico; Aspergillus sección Fumigati (posiblemente A. fumigatus). La evolución postoperatoria fue rápida y satisfactoria, sin requerir uso de antifúngicos, sólo aseos frecuentes de la cavidad operada hasta obtener una mucosa indemne y ventilada.

A case based on a clinical, radiologic, endoscopic and histologic diagnosis of a chronic non invasive sinusitis in a female 40 aged patient suffering from a purulent unilateral right rhinorrea which had been developing for several years is herein described. TAC revealed acertain masking of the maxilar sinus and calcifications which denoted a probable micotic infection yet mycological cultivations were not demanded. Surgery on the maxilar sinus by means of a medium antrotomy under endoscopy was indicated. The histologic diagnosisrevealed abundant non invasive septated, branched hyphae in the sinusal mucosa as well as some asexualmorphological structures which pointed to a particular taxonomic group; Aspergillus section Fumigati (possiblyA.fumigatus). Postoperatory evolution was fast and satisfactory since there was no need of using antifungaldrug, just frequent washing of the operated cavity until an undamaged and ventilated mucosa could be reached.

Estudio de funcionalidad y de comorbilidad en adultos mayores hospitalizados en el servicio de medicina del hospital de Peñablanca / Study of functionality and comorbility of elderly patients admitted to the medical service of the hospital de Peñablanca

En la actualidad la población adulta mayor de Chile ha aumentado a un 7,2 por ciento de la población total y seguirá creciendo de acuerdo a la transición demográfica en la que nuestro país se encuentra. Esto ha obligado a cambiar la forma de enfrentamiento del paciente anciano, debiendo considerar la cronicidad y la discapacidad en el primer encuentro médico-paciente. El presente estudio corresponde a una muestra inicial de tipo transversal y descriptivo para determinar la prevalencia de discapacidad y de comorbilidad en 80 pacientes hospitalizados en el Servicio de Medicina del Hospital de Peñablanca. Se usó como instrumento la escala de Barthel y Lawton-Brody para medir independencia para actividades básicas e instrumentales, respectivamente. Los resultados muestran que el 76 por ciento de los pacientes presenta algún grado de dependencia para actividades básicas y que sólo un 16 por ciento presenta independencia total para actividades instrumentales. Todo lo anterior nos debe hacer reflexionar sobre la forma de enfrentar al adulto mayor y su patología, para lograr una mejor inserción social libre de discapacidad.