Prevalencia de factores asociados al acceso venoso periférico difícil en población pediátrica en un hospital chileno / Prevalence of factors associated with difficult peripheral venous access in a paediatric population in a Chilean hospital / Prevalência de fatores associados ao acesso venoso periférico difícil em uma população pediátrica em um hospital chileno

INTRODUCCIÓN: La mitad de las instalaciones pediátricas de un catéter venoso periférico resultan ser en el contexto de un paciente, un acceso venoso difícil, definido como instalación de un catéter venoso periférico frustrado en la primera punción. Actualmente se utiliza como herramienta predictiva de acceso venoso difícil el DIVAscore, sin embargo, existen investigaciones que proponen nuevos factores asociados, surgiendo la necesidad de estudiarlos en profundidad. OBJETIVO: Identificar la prevalencia de factores asociados al acceso venoso difícil en pacientes pediátricos atendidos en el servicio de cirugía de un hospital en Chile, 2022. METODOLOGÍA: Investigación cuantitativa descriptiva transversal con muestreo intencionado. Fueron incluidos pacientes de edad entre 0a 14 años cumplidos con acceso venoso difícil. Para investigar estos antecedentes clínicos, se seleccionaron 5 de los más mencionados en la literatura: Obesidad, Diabetes, Anemia de Células Falciformes, Quimioterapia y Diálisis. Se utilizó una grilla de cotejo realizada Ad Hoc, los resultados fueron analizados mediante un software y el intervalo de confianza fue de 95%. RESULTADOS: La mediana de edad fue de 1 año, con un rango intercuartílico de 3. El antecedente evaluado más prevalente en los pacientes con acceso venoso difícil fue obesidad, presente en el 31% de la muestra y el segundo, fue anemia de células falciformes, presente en un 5%. CONCLUSIONES: Se evidenció una amplia diferencia entre las variables estudiadas, siendo obesidad la de mayor prevalencia; la investigación logró el propósito de aportar evidencia que ayude a la toma de decisiones para el cuidado del capital venoso del paciente.

INTRODUCTION: Half of the pediatric installations of a peripheral venous catheter turn out to be in the context of a patient, a difficult venous access, defined as the installation of a peripheral venous catheterfrustrated in the first puncture. Currently, the DIVAscore is used as a predictive tool for difficult venous access, however, there is research that proposes new associated factors, arising the need to study them in depth. AIM:To identify the prevalence of factors associated with difficult venous access in pediatric patients treated in the surgery service of a hospital in Chile, 2022. METHODOLOGY: Cross-sectional descriptive quantitative research with purposive sampling. Patients aged 0 to 14 years with difficult venous access were included. To investigate these clinical antecedents, 5 of the most mentioned in the literature were selected: Obesity, Diabetes, Sickle Cell Anemia, Chemotherapy and Dialysis. An Ad Hoc comparison grid was used, the results were analyzed using software and the confidence interval was 95%. RESULTS:The median age was 1 year, with an interquartile range of 3. The most prevalent antecedent evaluated in patients with difficult venous access was obesity, present in 31% of the sample and the second, was sickle cell anemia, present in 5%. CONCLUSIONS: A wide difference was evidenced between the variables studied, with obesity being the most prevalent; the research achieved the purpose of providing evidence that helps decision-making for the care of the patient's venous capital.

INTRODUÇÃO: Metade das instalações pediátricas de um cateter venoso periférico acaba por ser no contexto de um paciente, um acesso venoso difícil, definido como a instalação de um cateter venoso periférico frustrado na primeira punção. Atualmente, o DIVAscore é utilizado como ferramenta preditiva para acesso venoso difícil, entretanto, há pesquisas que propõem novos fatores associados, surgindo a necessidade de estudá-los a fundo. OBJETIVO: Identificar a prevalência de fatores associados à dificuldade de acesso venoso em pacientes pediátricos atendidos no serviço de cirurgia de um hospital no Chile, 2022. METODOLOGIA: Pesquisa quantitativa descritiva transversal com amostragem intencional. Foram incluídos pacientes de 0 a 14 anos com acesso venoso difícil.Para investigar esses antecedentes clínicos, foram selecionados 5 dos mais citados na literatura: Obesidade, Diabetes, Anemia Falciforme, Quimioterapia e Diálise. Uma grade de comparação Ad Hoc foi usada, os resultados foram analisados usando software eo intervalo de confiança foi de 95%.RESULTADOS: A mediana de idade foi de 1 ano, com intervalo interquartil de 3. O antecedente mais prevalente avaliado em pacientes com acesso venoso difícil foi a obesidade, presente em 31% da amostra e o segundo, foi aanemia falciforme, presente em 5 %. CONCLUSÕES: Evidenciou-se ampla diferença entre as variáveis estudadas, sendo a obesidade a mais prevalente; A pesquisa atingiu o objetivo de fornecer evidências que auxiliem na tomada de decisão para o cuidado com o capital venoso do paciente.

How to Manage Patients with Lenalidomide-Refractory Multiple Myeloma.

Although lenalidomide-based combinations, such as lenalidomide plus a proteasome inhibitor or an anti-CD38 monoclonal antibody, improve the overall response rate, progression-free survival, and overall survival of patients with relapsed/refractory multiple myeloma (RRMM), there is a tendency to use these regimens as a frontline treatment. This strategy has led to the development of refractoriness early in the disease course, usually after the patient's first treatment. Since lenalidomide-free regimens have so far shown limited efficacy in lenalidomide-refractory patients, there is an unmet need for other treatment options. In this review, we discuss the therapeutic options available to treat the general population of lenalidomide-refractory patients (mono, double and triple refractory) and the subpopulation of patients with other high-risk features such as renal failure, extramedullary disease, and high-risk cytogenetics. Moreover, new promising individual therapies and the possible impact of immunotherapy in RRMM patients are debated.

Inequidades y COVID-19 en 15 comunas de la Región Metropolitana: una mirada descriptiva de enfermería / Inequities and COVID-19 in 15 municipalities of the Metropolitan Region: a nursing ́s descriptive view / Desigualdades e COVID-19 em 15 municípios da Região Metropolitana: uma visão descritiva da enfermagem

INTRODUCCIÓN: La pandemia por COVID-19 ha impactado a Chile y particularmente a la Región Metropolitana, la que se caracteriza por ser un territorio desigual. La distribución de las infecciones por SARS-CoV2 no ha impactado a la población de forma equitativa y depende de algunos Determinantes Sociales de la Salud (DDSS). OBJETIVO: Describir la incidencia de casos COVID-19 notificados en comunas de la RM según etnia, años de escolaridad, pobreza, hacinamiento y movilidad. METODOLOGÍA: Estudio descriptivo, ecológico y transversal. Se escogieron grupos de comunas según el Índice de Prioridad Social y luego se seleccionaron 15 comunas de forma aleatoria por conglomerados. Se describió la situación epidemiológica según DDSS mencionados. RESULTADOS: Las comunas con mayor prioridad social y más vulnerables respecto a DDSS mostraron altas tasas de incidencia por COVID-19. Al mismo tiempo, aquellas con menor hacinamiento y movilidad evidenciaron las menores tasas de incidencia. CONCLUSIÓN: Para promover la salud y evitar enfermar es necesario comprender las discrepancias del contexto entre personas y comunidades. Las diferencias en las tasas de incidencia por comuna expresan también diferencias sociales que deben ser abordadas con el fin apuntar a las causas estructurales del proceso salud-enfermedad.

INTRODUÇÃO: A pandemia COVID-19 afetou o Chile, particularmente a Região Metropolitana, que se caracteriza como um território desigual. A distribuição do SARS-Cov2 não tem impactado a população de maneira igual e depende dos Determinantes Sociais da Saúde. OBJETIVO: Descrever a incidência do COVID-19 nos municípios da Região Metropolitana por etnia, anos de escolaridade, pobreza, superlotação e mobilidade. METODOLOGÍA: Estudo transversal, descritivo e ecológico. Grupos de municípios foram selecionados pelo Índice de Prioridade Social, em seguida, 15 municípios foram selecionados aleatoriamente. A situação epidemiológica foi descrita de acordo com oreferido Determinantes Sociais da Saúde. RESULTADOS: Municípios com maior prioridade social e mais vulneráveis apresentaram altas taxas de COVID-19. Ao mesmo tempo, municípios com menor superlotação e mobilidade apresentaram menores taxas de COVID-19. CONCLUSÃO:Para promover a saúde e evitar doenças é fundamental conhecer os diferentes contextos entre as pessoas e a comunidade. As diferenças nas taxas de COVID-19 pelos municípios, mostram desigualdades sociais que devem ser enfrentadas atendendo aos fatores estruturais da saúde.

To describe the COVID-19 incidence in the Metropolitan Region ́s municipalities by Etnia, years of education, poverty, overcrowding,and mobility. METHODOLOGY: Cross-sectional, descriptive,and ecological study. Social Priority Index selected groups of municipalities, then 15 municipalities were randomly selected. The epidemiological status was described by mentioned Social Determinant of Health. RESULTS: Municipalities with higher social priority and more vulnerable showed high rates of COVID-19.At the same time, municipalities with less overcrowding and mobility showed lower COVID-19 rates. CONCLUSION: In this way, promoting health and avoiding getting sick, it is necessary to understand the differences between people and communities. The different rates of COVID-19 by municipalities show social inequalities that must be tackled attending the structural factors of health

COVID-19 incidence and mortality in the Metropolitan Region, Chile: Time, space, and structural factors.

Demographic, health, and socioeconomic factors significantly inform COVID-19 outcomes. This article analyzes the association of these factors and outcomes in Chile during the first five months of the pandemic. Using the municipalities Metropolitan Region's municipalities as the unit of analysis, the study looks at the role of time dynamics, space, and place in cases and deaths over a 100-day period between March and July 2020. As a result, common and idiosyncratic elements explain the prevalence and dynamics of infections and mortality. Social determinants of health, particularly multidimensional poverty index and use of public transportation play an important role in explaining differences in outcomes. The article contributes to the understanding of the determinants of COVID-19 highlighting the need to consider time-space dynamics and social determinants as key in the analysis. Structural factors are important to identify at-risk populations and to select policy strategies to prevent and mitigate the effects of COVID-19. The results are especially relevant for similar research in unequal settings.

Green Space Exposure Association with Type 2 Diabetes Mellitus, Physical Activity, and Obesity: A Systematic Review.

Type 2 diabetes mellitus (T2DM) is a public health challenge that must be addressed considering the large number of risk factors involved in its appearance. Some environmental risk factors are currently described as predictors of diabetes, with access to green spaces being an element to consider in urban settings. This review aims to study the association between exposure to green spaces and outcomes such as diabetes, obesity, and physical activity in the general population. A systematic review was carried out using the PubMed, Embase, and LILACS databases and other sources. The search strategy was carried out from October 2019 to October 2020. Cross-sectional and cohort studies were included. The article selection was made by a pair of reviewers, and data extraction was carried out using a data extraction sheet. The quality assessment of the included studies was carried out using a validated tool. Finally, 19 scientific articles were included in this review. Evidence supports that people and communities exposed to green spaces, especially in their neighborhood, reduce the risk of T2DM and reduce the risk of being obese and increase the likelihood of physical activity. The onset of T2DM can be moderated by using green spaces, improving physical activity levels, and reducing the risk of being overweight and obese.

Adverse event management in the TOURMALINE-MM3 study of post-transplant ixazomib maintenance in multiple myeloma.

The phase 3, double-blind, placebo-controlled TOURMALINE-MM3 study (NCT02181413) demonstrated improved progression-free survival with ixazomib maintenance versus placebo post autologous stem cell transplant (ASCT) in multiple myeloma patients. We report additional safety data from TOURMALINE-MM3 to inform adverse event (AE) management recommendations. Patients were randomized 3:2 to receive ixazomib (n = 395) or placebo (n = 261) on days 1, 8, and 15 of 28-day cycles for ~ 2 years or until progressive disease/toxicity. The initial 3-mg ixazomib dose was escalated to 4 mg in cycle 5, if tolerated in cycles 1-4. Safety was a secondary endpoint assessed in all treated patients; AEs were graded using Common Terminology Criteria for AEs v4.03. The rate of grade ≥ 3 AEs was higher in the ixazomib arm (19%) than in the placebo arm (5%), but the rate of discontinuation due to AEs was similar (7% vs. 5%). For AEs of clinical interest, rates were higher with ixazomib versus placebo: nausea 39% versus 15%, vomiting 27% versus 11%, diarrhea 35% versus 24%, thrombocytopenia 13% versus 3%, and peripheral neuropathy 19% versus 15%. However, the majority of events were low-grade, manageable with supportive therapy or dose reduction, and reversible, and did not result in discontinuation. There was no evidence of cumulative, long-term, or late-onset toxicity with ixazomib maintenance. Ixazomib is an efficacious and tolerable option for post-ASCT maintenance. AEs associated with ixazomib maintenance can be managed in the context of routine post-ASCT supportive care due to the limited additional toxicity. ClinicalTrials.gov NCT02181413.

Subcutaneous bortezomib in newly diagnosed patients with multiple myeloma nontransplant eligible: Retrospective evaluation.

Bortezomib-melphalan-prednisone combination is one of the standards of care for nontransplant eligible patients with newly diagnosed multiple myeloma. However, bortezomib intravenous (twice weekly for 4 cycles then weekly for 5 cycles) results in ~13% of patients with grade 3-4 peripheral neuropathy. Bortezomib subcutaneous (SQ) and weekly delivery, improves tolerability without impairment of efficacy. The aim of this study was to evaluate the safety and effectiveness of SQ bortezomib-based combinations in nontransplant eligible patients with newly diagnosed myeloma in a real-world setting. A total of 135 patients (median age [range] = 76 [58-89], International Staging System-III = 54%, median follow-up = 14.8 months [1-40], Intensive group [twice weekly bortezomib] = 65%, Optimized group [weekly bortezomib] = 35%) were included and evaluable for safety, whereas 121 were evaluable for effectiveness. Overall response rate (95% CI) was 61% (53%, 71%) (complete response = 27%, very good partial response = 13%, and partial response = 21%) and median progression-free survival was 22.2 months (95% CI: 16.1-not reached). The 3-year overall survival was 75%. The most frequent grade 3-4 adverse events were thrombocytopenia (18%), neutropenia (17%), and anemia (11%). Peripheral neuropathy of any grade was observed in 44% of patients (2% with grade 3). Comparison between regimens (Intensive vs Optimized) showed similar overall response rate (57% vs 70%) and PFS (25 vs 19 months). A similar safety profile was observed between regimens. Thus, SQ bortezomib showed similar effectiveness and better tolerability as compared with results from intravenous bortezomib studies, and showing no differences either in effectiveness or safety in different bortezomib-based combinations.

Estimating the burden of influenza-associated hospitalizations and deaths in Chile during 2012-2014.

BACKGROUND: Influenza is a vaccine preventable disease that causes important morbidity and mortality worldwide. Estimating the burden of influenza disease is difficult. However, there are some methods based in surveillance data and laboratory testing that can be used for this purpose. OBJECTIVES: Estimating the burden of serious illness from influenza by means of hospitalization and death records during the period between 2012 and 2014, and using information from Severe Acute Respiratory Illness (SARI) surveillance. METHODS: To estimate the Chilean rate of influenza-associated hospitalizations and deaths, we applied the influenza positivity of respiratory samples tested in six SARI surveillance sentinel hospitals to the hospitalizations and deaths from the records with ICD-10 codes from influenza and pneumonia. RESULTS: Annually, 5320 people are hospitalized for influenza and 447 die for this cause. The annual influenza-associated hospitalization rate for the period was 71.5/100 000 person-year for <5 years old, 11.8/100 000 person-year for people between 5 and 64 years old; and 156.0/100 000 person-year for ≥65 years. The annual mortality rate for the period was 0.08/100 000 person-year for <5 years; 0.3/100 000 person-year for people between 5 and 64 years; and 22.8/100 000 person-year for ≥65 years. CONCLUSIONS: This is the first study of influenza burden in Chile. Every year an important quantity of hospitalizations and deaths result from influenza infection. In countries in temperate zones, it is important to know the burden of influenza in order to prepare the health care network and to assess preventive intervention currently in practice and the new ones to implementing.

Cambra system in patients awaiting hematopoietic progenitor cell transplant and high caries risk.

BACKGROUND: Recent times have witnessed a significant increase in the number of patients affected by problems related to oncological treatment Aims of this study is to evaluate dental affectation among patients awaiting hematopoietic progenitor cell transplant (HPCT), and they showed high caries risk, so it should establish a protocol prior to transplantation. MATERIAL AND METHODS: The study included 72 patients due for HPCT. Clinical and radiological explorations were performed and oral photos taken. The amount of caries, missing teeth and fillings were registered for each patient. CAO, DMFS and Restoration Indices were calculated. RESULTS: 83% of patients presented caries. 48 patients (67%) had lost at least one tooth. Only 32 patients (44%) had received some sort of conservative treatment. The average CAO index value obtained was 10.37. The DMFS index showed an average of 27.06 affected surfaces. Of the 72 patients studied, 40 (56%) showed a restoration index value of zero. CONCLUSIONS: These patients presented a high number of carious teeth and a low restoration index. The presence of so many possible septic foci in an individual, who will later become susceptible to infection, highlights the importance of preventative treatment and bucco-dental restoration within this patient population. These patients with a high caries risk can be treated with CAMBRA system. Key words:Hematopoietic progenitor cell transplantation, high caries risk, state of oral health, haematological disease, CAMBRA system.

Prevalencia de infecciones de transmisión sexual en mujeres embarazadas atendidas en un hospital público de Chile / Prevalence of sexually transmitted infections in pregnant women attending a public hospital in Chile

Introduction: The epidemiologic rates of gonorrhea have declined steadily in Chile, while the incidence of infections with Trichomonas vaginalis and Chlamydia trachomatis is not well known. Aim: Since these sexually transmitted infections (STIs) are associated with adverse pregnancy outcomes and perinatal infections, this study aimed to update their prevalence in a public hospital in the Metropolitan Region of Chile. Patients and Methods: Between April and October 2010 and April and October 2011, pregnant women attending the antenatal Service, Hospital San Borja Arriarán, were randomly selected for detection of T. vaginalis, N. gonorrhoeae and C. tra-chomatis by culture in modified Diamond's broth, Thayer-Martin agar, and by omp1 gene amplification by nested PCR, respectively. We excluded pregnant women who received antibiotics within the past 30 days. Results: Two hundred and fifty five cervicovaginal samples were analyzed. C. trachomatis was detected in 15 (5.9%) and T. vaginalis in 6 (2.4%). N. gonorrhoeae was not found. Conclusion: The results show low prevalence of C. tracho-matis and T. vaginalis and absence of N. gonorrhoeae. These rates have remained stable at this medical center since the 1990s, with a slight increase in C. trachomatis.

Introducción: Las tasas epidemiológicas de gonorrea han disminuido constantemente en Chile, mientras que la incidencia de infecciones por Trichomonas vaginalis y Chlamydia trachomatis no es bien conocida. Estas infecciones de transmisión sexual (ITSs) están asociadas con resultados adversos del embarazo e infecciones peri-natales. Objetivo: Actualizar su prevalencia en un hospital público de la Región Metropolitana de Chile. Pacientes y Métodos: Entre abril y octubre de 2010 y desde abril a octubre de 2011, fueron seleccionadas al azar mujeres embarazadas atendidas en el Servicio de atención prenatal del Hospital San Borja Arriarán para detección de T. vaginalis, N. gonorrhoeae y C. trachomatis, por cultivo en caldo Diamond modificado, cultivo en Thayer-Martin y mediante amplificación del gen omp1, por RPC anidada, respectivamente. Se excluyeron mujeres embarazadas que recibieron antimicrobianos los 30 días previos. Resultados: Se analizaron 255 muestras cérvico-vaginales. C. trachomatis fue detectada en 15 (5,9%) de las mujeres embarazadas. T. vaginalis se aisló en 6 (2,4%) de ellas, mientras que N. gonorrhoeae no se encontró en las gestantes. Conclusión: Los resultados muestran prevalencia baja de C. trachomatis y de T. vaginalis y ausencia de N. gonorrhoeae, proporción que se mantiene estable en este establecimiento desde la década de 1990s, con leve aumento de C. trachomatis.

Influence of oral health on mucositis in patients undergoing hematopoietic progenitor cell transplantation (HPCT)

Aims: To establish whether or not the state of patient oral health can influence the occurrence and/or severity of oral mucositis during hematopoietic progenitor cell transplantation (HPCT).Materials and Methods: The study included 72 patients awaiting HPCT. Prior to transplantation, clinical exploration and radiology were carried out and oral photographs were taken. This evaluated the extent of caries present, the number of missing teeth and the number of dental fillings in each patient; CAO (Caries and Obturations Index)DMFS (Decayed, Missing, and Filled Surfaces) and Restoration Indices were calculated. Gingival pathology was also examined by means of the Ainamo and Bay Gingival Bleeding Index. O’Leary’s Plaque Index was used to evaluate the level of patient oral hygiene. This data was analyzed to see if it exercised any influence on the mucositis grade suffered during HPCT. Results: 96,87% of patients suffered some degree of mucositis during their treatment by the Transplant Unit. The grade of mucositis was seen to be influenced by the number of missing teeth (ANOVA p<0.016) and by the DMFS Index (ANOVA p< 0.038). Although this was not one of the aims of this study, patient age and the administration of colony-stimulating factors were also seen to influence these clinical manifestations. Conclusions: The state of prior oral health can influence decisively the mucositis suffered during transplantation (AU)

Influence of oral health on mucositis in patients undergoing hematopoietic progenitor cell transplantation (HPCT).

AIMS: To establish whether or not the state of patient oral health can influence the occurrence and/or severity of oral mucositis during hematopoietic progenitor cell transplantation (HPCT). MATERIALS AND METHODS: The study included 72 patients awaiting HPCT. Prior to transplantation, clinical exploration and radiology were carried out and oral photographs were taken. This evaluated the extent of caries present, the number of missing teeth and the number of dental fillings in each patient; CAO (Caries and Obturations Index) DMFS (Decayed, Missing, and Filled Surfaces) and Restoration Indices were calculated. Gingival pathology was also examined by means of the Ainamo and Bay Gingival Bleeding Index. O'Leary's Plaque Index was used to evaluate the level of patient oral hygiene. This data was analyzed to see if it exercised any influence on the mucositis grade suffered during HPCT. RESULTS: 96,87% of patients suffered some degree of mucositis during their treatment by the Transplant Unit. The grade of mucositis was seen to be influenced by the number of missing teeth (ANOVA p<0.016) and by the DMFS Index (ANOVA p< 0.038). Although this was not one of the aims of this study, patient age and the administration of colony-stimulating factors were also seen to influence these clinical manifestations. CONCLUSIONS: The state of prior oral health can influence decisively the mucositis suffered during transplantation.

[Prevalence of sexually transmitted infections in pregnant women attending a public hospital in Chile]. / Prevalencia de infecciones de transmisión sexual en mujeres embarazadas atendidas en un hospital público de Chile.

INTRODUCTION: The epidemiologic rates of gonorrhea have declined steadily in Chile, while the incidence of infections with Trichomonas vaginalis and Chlamydia trachomatis is not well known. AIM: Since these sexually transmitted infections (STIs) are associated with adverse pregnancy outcomes and perinatal infections, this study aimed to update their prevalence in a public hospital in the Metropolitan Region of Chile. PATIENTS AND METHODS: Between April and October 2010 and April and October 2011, pregnant women attending the antenatal Service, Hospital San Borja Arriarán, were randomly selected for detection of T. vaginalis, N. gonorrhoeae and C. trachomatis by culture in modified Diamond's broth, Thayer-Martin agar, and by omp1 gene amplification by nested PCR, respectively. We excluded pregnant women who received antibiotics within the past 30 days. RESULTS: Two hundred and fifty five cervicovaginal samples were analyzed. C. trachomatis was detected in 15 (5.9%) and T. vaginalis in 6 (2.4%). N. gonorrhoeae was not found. CONCLUSION: The results show low prevalence of C. trachomatis and T. vaginalis and absence of N. gonorrhoeae. These rates have remained stable at this medical center since the 1990s, with a slight increase in C. trachomatis.

[Nugent and Spiegel criteria for the diagnosis of bacterial vaginosis. Analysis of discordant specimens by the Ison and Hay method]. / Comparación de los criterios de Nugent y Spiegel para el diagnóstico de vaginosis bacteriana y análisis de los resultados discordantes por el método de Ison y Hay.

BACKGROUND: Vaginal infection is the commonest cause of genital symptoms and has obstetric and gynecological implications. AIM: To compare the Nugent and Spiegel methods for the diagnosis of bacterial vaginosis (BV) and to analyze discordant specimens using Ison and Hay (Ison/Hay) criteria. MATERIAL AND METHODS: After discarding cases with Candidiasis, deficient specimens or those lacking bacteria, a total of 348 Gram-stained smears vaginal specimens received for the diagnosis of BV, were analyzed. RESULTS: Vaginal microbiota was classified as normal in 203 and 237 samples (58 and 68% of samples), according to Nugent and Spiegel criteria, respectively One hundred and five (30%) and 111 samples (32%), were classified as VB according to Nugent and Spiegel criteria, respectively. Both criteria were concordant in 308 samples (88.5%). The 40 (11.5%) discordant specimens were classified as intermediate microflora by the Nugent system and as normal or BV by Spiegel. Among these, the Ison/Hay procedure identified four categories of microbiota. Ten (25%) specimens were classified as grade II microbiota, confirming their categorization by Nugent as intermediate microbiota, six (15%) were classified in the III category, confirming the diagnosis of BV by Spiegel, 13 (32.5%) corresponded to the category III, that does not exist in the Nugent and Spiegel categorization systems. Finally, 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. CONCLUSIONS: The systems proposed by Spiegel, Nugent and Ison/Hay are comparable for the diagnosis of BV. However, we recommend the use of Ison/Hay procedure to evaluate vaginal microbiota, due to its wider range of categories, allowing a better discrimination of the vaginal microbiota.

Comparación de los criterios de Nugent y Spiegel para el diagnóstico de vaginosis bacteriana y análisis de los resultados discordantes por el método de Ison y Hay / Nugent and Spiegel criteria for the diagnosis of bacterial vaginosis. Analysis of discordant specimens by the Ison and Hay method

Background: Vaginal infection is the commonest cause of genital symptoms and has obstetric and gynecological implications. Aim: To compare the Nugent and Spiegel methods for the diagnosis of bacterial vaginosis (BV) and to analyze discordant specimens using Ison and Hay (Ison/Hay) criteria. Material and Methods: After discardingcases with Candidiasis, deficientspecimens or those lacking bacteria, a total of348 Gram-stained smears vaginal specimens receivedfor the diagnosis of BV, were analyzed. Results: Vaginal microbiota was classified as normal in 203 and 237 samples (58 and 68 percent of samples), accordingto Nugent and Spiegel criteria, respectively One hundred andfive (30 percent) and 111 samples (32 percent), were classified as VB accordingto Nugent and Spiegel criteria, respectively. Both criteria were concordant in 308 samples (88.5 percent). The 40 (11.5 percent) discordant specimens were classified as intermedíate microflora by the Nugent system and as normal or BV by Spiegel. Among these, the Ison/Hay procedure identified four categories of microbiota. Ten (25 percent) specimens were classified as grade II microbiota, confirming their categorization by Nugent as intermedíate microbiota, six (15 percent) were classified in the III category, confirming the diagnosis ofBV by Spiegel, 13 (32.5 percent) corresponded to the category III, that does not exist in the Nugent and Spiegel categorization systems. Finally, 11 specimens could not be assigned to one category due to microscopic limitations to distinguish bacterial morphotypes. Conclusions: The systems proposed by Spiegel, Nugent and Ison I Hay are comparable for the diagnosis of BV. However, we recommend the use of Ison/ Hay procedure to evalúate vaginal microbiota, due to its wider range of categories, allowing a better discrimination ofthe vaginal microbiota.

Flutter auricular asociado a un aneurisma del septum interatrial, sometido a ablación con radiofrecuencia / Atrial flutter associated to atrial septal aneurysm treated with radiofrequency ablation

Presentamos el caso de un adulto joven que inició con un flutter atrial (F1-A) tipo I, de difícil manejo farmacológico, en el cual el único hallazgo anormal documentado en un ecocardiograma fue la presencia de un aneurisma septal a nivel de la fosa oval. Durante un estudio electrofisiológico (EEF) de registró un F1A con ciclos atriales de 233 m seg para una frecuencia atrial de 257 lpm, con una conducción AV de 2:1 y 3:1. Las ondas de flutter fueron negativas en las derivaciones inferiores (II, III, a VF), sugiriendo una activación caudo-cefálica, característica del F1A tipo I (común). Esto fue confirmado mediante los registros intracavitarios de la secuencia de activación auricular. Se realizó un mapeo con el objeto de localizar la zona de conducción lenta e intentar la ablación con radiofrecuencia (RF). Se encontraron registros adecuados a nivel del istmo cavo-tricuspídeo, por lo que se procedió a la aplicación de la RF en esta zona. Después de las 10 primeras descargas de RF, el paciente continuaba con la taquiarritmia. Con estimulación atrial incremental se logró el arrastre del F1A, el cual fue suprimido. Después de 6 descargas más de RF en esa misma zona y durante ritmo sinusal, se intentó inducir de nuevo del F1A mediante estimulación eléctrica programada, sin lograrlo. Al final del procedimiento, el paciente quedó en ritmo sinusal, sin complicaciones. Un día después se escontraba asintomático, se egresó sin tratamiento antiarrítmico. Fue valorado por su médico tratante a los 15 días posteriores a la ablación, encontrándolo asintomático. Un mes después, la arritmia recurrió, por lo que se sometió a una segunda sesión exitosa de radiofrecuencia. Se hizó una revisión de la literatura acerca de los aneurismas atriales y algunas complicaciones asociadas a éstos (principalmente las arritmias supraventriculares). Así como del F1A tipo I, las técnicas para su mapeo y los resultados de la ablación en este tipo de arritmia

Insuficiencia mitral post-valvuloplastía mitral con catéter balón: incidencia, factores predictores y pronóstico / Mitral regurgitation following ballon-catheter mitral valvuloplasty

Un total de 205 pacientes con diagnóstico de estenosis mitral reumática, fueron sometidos a VMTP de octubre de 1990 a octubre de 1993: 178 mujeres y 27 hombres, con edades de 16 a 72 años, media de 38. La incidencia global de insuficiencia mitral fue de 10 por ciento antes de VMPT y de 37 por ciento post-VMPT (p<0.05): fue considerada grado I en 45 pacientes (22 por ciento), grado II en 24 pacientes (12 por ciento), grado III en 4 pacientes (2 por ciento) y grado IV en 3 pacientes (1.5 por ciento), con p de 0.003, 0.002, N.S. y N.S. respectivamente. De los 205 pacientes, 83 (40 por ciento) permanecieron sin cambios en la aparición y/o progresión de la I.M., en 55 pacientes (26.8 por ciento) apareció I.M. de novo (p0.004), en 47 pacientes (23 por ciento) la I.M. aumentó un grado (p0.002) y en 20 pacientes (9.7 por ciento) la I.M. aumentó 2 o más grados (p0.007). De las 138 comisurotomías realizadas con catéter de Inoue, la incidencia de I.M. fue de 56 pacientes (40.5 por ciento), mientras que de las 67 realizadas con doble balón fue de 11 pacientes (16.4 por ciento) p0.03. En cuanto a la severidad de la I.M. con técnica de Inoue y doble balón fue: grado I en 27 por ciento vs 9 por ciento (p0.001), grado II 9.4 por ciento vs 6 por ciento (p o.05), grado III 2.1 por ciento vs 1.5 por ciento (N.S.), y grado IV 2.1 por ciento vs 0 por ciento (N.S.). Sólo la presencia de calcio en las comisuras, y una puntuación ecocardiográfica mayor de 8 puntos, fueron encontradas como variables independientes predictoras de I.M. severa. La insuficiencia mitral leve y moderada, es frecuente en los pacientes sometidos VMTP, siendo mayor cuando es realizada con catéter de Inoue con relevancia estadística. En su forma severa, la insuficiencia mitral post-VMTP es poco frecuente, y también se aprecia más comúnmente si es realizada con catéter de Inoue, aunque sin alcanzar significancia estadística

Ablación con radiofrecuencia en una taquicardia ventricular idiopática originada en el ventrículo derecho / Radiofrequency ablation in idiopathic ventricular tachycardia that originated in the righ ventricle

Se informa el caso de un paciente de 10 años de edad, con corazón estructuralmente normal. En los últimos 2 años inició con episodios repetitivos de taquicardia ventricular monomórfica sostenida con frecuencia cardiaca hasta de 280 lpm, morfología de BRIHH con AQRS a +60º; acompañados de palidez y diaforesis. Cedían con la infusión I.V. de xilocaína. Recibió tratamiento con propafenona, verapamil y posteriormente con amiodarona, a pesar de lo cual persistía con crisis de taquicardias ventriculares sostenidas, aproximadamente 2 a 3 veces al mes. Se realizó un estudio electrofisiológico endocavitario que mostró una taquicardia ventricular originada en el infundíbulo del ventrículo derecho. Se tomó una biopsia endomiocárdica que fue normal. Posteriormente se programó para un intento de ablación de dicha taquicardia por medio de la aplicación de energía de radiofrecuencia a através de un catéter transvenoso. Durante este procedimiento, la taquicardia clínica se desencadenó fácilmente en forma espontánea, se hizo un mapeo de la activación ventricular más precoz y topoestimulación, mediante lo cual se localizó el punto de salida de la taquicardia clínica en la región posterior del tracto de salida del ventrículo derecho. Aquí utilizando 6 aplicaciones de radiofrecuencia con una energía de 40 watts durante 30 segundos, cedió la taquicardia ventricular a los 3 latidos pasando a ritmo sinusal. Posteriormente se realizó la estimulación eléctrica programada en la ápex del ventrículo derecho, sin que se lograra inducir nuevamente la taquicardia. Cuatro meses después el paciente se encuentra asintomático.

Tratamiento de la estenosis mitral severa mediante comisurotomía transvenosa percutánea / Treatment of severe mitral stenosis by balloon catheter percutaneous transvenous commissurotomy

Seleccionamos 110 pacientes adultos, 87.1 por ciento mujeres, (edad promedio 38.2 años, límites 16 a 72) con estenosis mitral (EM) severa sintomática, candidatos a valvotomía quirúrgica, para tratamiento alternativo mediante dilatación mitral transversa percutánea (CMTP). Se utilizó el catéter de Inoue en 80 casos (72.7 por ciento) y doble catéter-globo en 30 (27.3 por ciento). El procedimiento se realizó con éxito en 102 pacientes (92.7 por ciento, 2do. intento en 5), con resultados óptimo en 96 (87.3 por ciento); fracasó en un paciente (0.9 por ciento) por dificultad técnica; se complicó en 3 (2.7 por ciento) por perforación de cámara cardíaca, en 4/106 pacientes (3.8 por ciento) insuficiencia mitral severa. El área valvular mitral se incrementó de 1.09 ñ 0.27 a 2.6 ñ 0.87 cm² (p<0.0001); el gradiente transvalvular mitral disminuyó del 18.9 ñ 5.9 a 3.6 ñ 2.8 mmHg (p<0.0001); igualmente descendieron la presión media auricular izquierda de 26 ñ 6.5 a 12.5 ñ 4.2 mmHg (p<0.0001), y la presión arterial pulmonar media de 38 ñ 17 a 26.2 ñ 10.4 mmHg (p<0.0005). En 12/106 pacientes (11.3 por ciento) apareció insuficiencia mitral, o se incrementó la preexistente en más de un grado, y en 86 (81.1 por ciento) no fue detectable. Durante el seguimiento promedio (100 casos) de 10.8 meses (límites 5 a 24), todos los pacientes mejoraron su clase funcional (83.1 por ciento asintomáticos) y conservaron su área valvular mitral según valoración ecocardiográfica. En conclusión, la CMTP es el tratamiento de elección para casos seleccionados de EM adquirida sintomática, con resultados funcionales inmediatos y tardíos comparables a la comisurotomía quirúrgica