Expanding Diagnostic Workup for hypertensive Intracerebral hemorrhage: a retrospective LATAM cerebrovascular registry comparison.

Background: The leading cause of spontaneous intracerebral hemorrhage (ICH) is hypertensive arteriolopathy. In addition to age and hypertension history, patients usually present other comorbidities that potentially increase morbimortality. Ancillary studies other than non-contrast computerized tomography (NCCT) may help clarify the diagnosis and increase the detection of potentially modifiable vascular risk factors. Unfortunately, their use is not routinely performed. Objective: The study aimed to determine the frequency of ancillary studies performed in patients with hypertensive ICH. Methods: We performed a retrospective analysis of three Latin American cerebrovascular registries from academic medical centers, analyzing the results with descriptive statistics focusing on diagnosis and short-term outcomes. Results: We analyzed a total of 1,324 patients (mean age 64 years). Hypertension and obesity were the most prevalent risk factors. Only 14% underwent MRI, 10.3% extracranial ultrasonography, and 6.7% echocardiography. Among the three registries, the Latin America Stroke Registry performed more ancillary studies. Most of the patients presented a poor clinical outcome and in-hospital death. Conclusions: The use of ancillary studies in the diagnostic workup of ICH was poor in the three registries, and mortality was high. The lack of ancillary studies performed may negatively impact outcomes.

[Primary resistance to anti tuberculosis drugs in Chile 2011-2012]. / Resistencia primaria a fármacos anti-tuberculosos en Chile 2011-2012.

UNLABELLED: This publication presents the results of the Chilean initial study of resistance to first line anti-tuberculous drugs. The study was carried out between 2011 and 2012 by the National Reference Laboratory of the Institute of Public Health, as part of the Drug Surveillance Resistance in tuberculosis (TB) promoted by the World Health Organization. METHODOLOGY: Cross-sectional study performed using cluster sampling, representative of the entire country as recommended by the World Health Organization. Susceptibility testing to isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide was performed through the proportion method or Wayne's enzymatic method, as appropriate. RESULTS: 594 susceptibility tests were performed, showing an overall level of TB drug resistance of 8.6% and a prevalence of multidrug resistance of 1.3%. Indeed, the study showed a decrease in streptomycin resistance and an increase of isoniazid resistance in both mono-resistance and accumulated resistance compared to previous studies. No cases of mono-resistance to rifampicin were detected. CONCLUSION: An increased resistance to anti-TB drugs in Chile is observed, which despite being still low, is no less worrisome. Since 2014 the monitoring of drug resistance to TB is universally performed to avoid sub - diagnosis and treat each case according to the susceptibility profile.

The Neuropsychiatric Side of Cerebral Venous Thrombosis: A Case of Delirium and Catatonia.

We report a patient with cerebral venous thrombosis who initially presented with psychosis and who then progressed to delirium and catatonia within a few days. Upon treatment and resolution of the thrombosis, she presented complete remission of the psychiatric disturbances. This case highlights a specific neuropsychiatric presentation of cerebral venous thrombosis involving psychosis, catatonia, and delirium, which, to our best knowledge, has not been reported in the neurological or psychiatric literature. However, it reminds us of mental status and behavioral abnormalities which are not infrequent features of cerebral venous thrombosis. This leads to a discussion regarding the psychopathology, etiology, and pathophysiology of the case.

Systemic inflammation May limit the effect of protein supplement on nutritional status in peritoneal dialysis.

BACKGROUND: Malnutrition and inflammation are highly prevalent and associated with poor outcomes in continuous ambulatory peritoneal dialysis (CAPD). Nutritional supplements are commonly used; however, presence of systemic inflammation could limit their effect. AIM: To evaluate the impact of systemic inflammation on nutritional status of CAPD patients receiving an oral protein supplement. METHODS: Prospective observational study; 34 malnourished patients (subjective global assessment; SGA) received both nutritional counseling and oral egg albumin-based protein supplement. During 6-month of follow-up, patients had monthly clinical, and quarterly biochemical and inflammation [interleukin 6 and high sensitivity C-reactive protein (hsCRP)] evaluations. According to baseline hsCRP, patients were classified in two groups: Inflammation (>3 mg/L) and No-inflammation (≤3 mg/L). RESULTS: Comparing baseline vs final, macronutrient intake and SGA increased in both groups, however, improvement of SGA was more marked in the No-inflammation group at the end of the study: 70% improved, 25% no change and 5% worsened (p = 0.001); whereas in the Inflammation group results were: 50% improved, 36% no change and 14% worsened (p = 0.03). Additionally, at final evaluation, serum albumin tended to increase more in the No-inflammation (3.0 ± 0.9 vs 3.4 ± 1.1 g/dL, p = 0.08) than in Inflammation group (2.8 ± 0.6 vs 3.0 ± 0.9 g/dL, p = 0.66), and body mass index significantly increased in No-inflammation group (20.3 ± 3.0 vs 21.6 ± 3.3 kg/m2, p < 0.001) but not in Inflammation group (21.9 ± 3.0 vs 22.5 ± 3.3 kg/m2, p = 0.09). CONCLUSIONS: The presence of systemic inflammation in malnourished CAPD patients seemed to limit the trend for improvement on nutritional status observed with counseling and oral egg albumin-based protein supplement in patients without inflammation.

[Detection of genes associated with drug resistance in Mycobacterium tuberculosis strains isolated in Chile]. / Detección de mutaciones asociadas a cepas multidrogo resistente de Mycobacterium tuberculosis en Chile.

BACKGROUND: The incidence of acquired resistance to antituberculous drugs of Mycobacterium tuberculosis in Chile is approximately 23%. AIM: To analyze the mutations associated with drug resistance in drug resistant strains of Mycobacterium tuberculosis. MATERIAL AND METHODS: In 28 drug resistant Mycobacterium tuberculosis strains isolated in Chile, genes leading to drug resistance were studied. DNA was amplified by polymerase chain reaction (PCR) and sequencing was carried out using the ABI PRISM big dye terminator cycle sequencing ready reaction kit. RESULTS: In rifampicin-resistant strains, the mutations in rpoß gene were in the codons S531W/L (56%), D516Y (16%) and D516V (16%). The predominant mutation in katG gene was in the codon S315L (73%) in isoniazid-resistant strains. The mutation S95T was found in the 71% of ciprofloxacin resistant strains. Only one ethambutol resistant strain had the M306I mutation. Three unreported mutations in katG were identified. CONCLUSIONS: Drug resistance associated mutations of Mycobacterium tuberculosis isolated in Chile were similar to those reported abroad.

Profesionalización de Enfermería Rural, circulación de saberes y políticas estatales de salud en La Araucanía-Chile, años 1970-1990 / Profissionalização da Enfermagem Rural, circulação do conhecimento e políticas estaduais de saúde em La Araucanía-Chile, 1970-1990 / Rural Nursing professionalization, knowledge circulation and state health policies in the Araucania region-Chile, 1970-1990

Con el objetivo de develar la profesionalización de la enfermería rural, sus saberes y las políticas de salud en la Región de La Araucanía-Chile, años 1970-1990, se realiza una investigación histórica, descriptiva. Se trabaja historia oral, incluyendo 8 enfermeras y un enfermero. Los datos se analizan por codificación en base a criterio temático. Se trabaja rigor con triangulación por investigador y criterios de Guba y Lincoln. Se respetan los principios éticos de Ezekiel Emanuel. Como resultado surgen las metacategorías: Ejercicio profesional de enfermería rural marcado por necesidades sociales, Dualidad del ejercicio profesional, Formación de auxiliares rurales-capacitación, Liderazgo en programas de salud y Transformación de las condiciones de vida personal. Se concluye que los enfermeros desempeñaron su rol del cuidado de la salud, con abnegación y sacrificio, con destacada vocación en base a las necesidades enfrentadas, debiendo adaptarse a la ruralidad, viviendo realidades complejas en un entorno de pobreza y vulnerabilidad social, desarrollándose personal y profesionalmente.(AU)

Aiming to reveal the rural nursing professionalization, knowledge circulation and statehealth policies in the Araucania region in Chile, from 1970 to 1990, a historical, descriptiveinvestigation is carried out. Oral history is worked, including 9 nurses through snowball sampling.The data are analysed by coding based on thematic criteria. Rigor is worked by researchertriangulation and Guba and Lincoln criteria. Ezekiel Emanuel's ethical principles are respected. Asa result, the following metacategories emerge: Professional rural nursing practice marked by socialneeds, Professional practice duality, Rural assistants training, Health programs leadership andPersonal living conditions transformation. It is concluded that nurses performed their role as healthcare managers with abnegation and prominent vocation based on the needs they faced, adaptingthemselves to rurality, living complex realities in an environment of poverty and socialvulnerability, thus, developing personally and professionally.(AU)

Com o objetivo de desvelar a profissionalização da enfermagem rural, seus conhecimentose políticas de saúde na região de La Araucanía-Chile, 1970-1990, é realizada uma investigaçãohistórica, descritiva. A história oral é trabalhada, incluindo 8 enfermeiros e um enfermeiro. Osdados são analisados por codificação com base em critérios temáticos. Trabalhamos rigorosamentecom a triangulação pelo pesquisador e pelos critérios de Guba e Lincoln. Os princípios éticos deEzequiel Emanuel são respeitados. Como resultado, emergem as metacategorias: Práticaprofissional de enfermagem rural marcada por necessidades sociais, Dualidade de práticaprofissional, Capacitação de auxiliares rurais, Liderança em programas de saúde e Transformaçãodas condições de vida pessoal. Conclui-se que os enfermeiros desempenharam seu papel naatenção à saúde, com auto-sacrifício e sacrifício, com uma vocação destacada com base nasnecessidades enfrentadas, tendo que se adaptar à ruralidade, vivendo realidades complexas em umambiente de pobreza e vulnerabilidade social, desenvolvendo pessoal e profissionalmente.(AU)

Analysis of Mycobacterium tuberculosis Genotypic Lineage Distribution in Chile and Neighboring Countries.

Tuberculosis (TB), caused by the pathogen Mycobacterium tuberculosis (MTB), remains a disease of high importance to global public health. Studies into the population structure of MTB have become vital to monitoring possible outbreaks and also to develop strategies regarding disease control. Although Chile has a low incidence of MTB, the current rates of migration have the potential to change this scenario. We collected and analyzed a total of 458 M. tuberculosis isolates (1 isolate per patient) originating from all 15 regions of Chile. The isolates were genotyped using the spoligotyping method and the data obtained were analyzed and compared with the SITVIT2 database. A total of 169 different patterns were identified, of which, 119 patterns (408 strains) corresponded to Spoligotype International Types (SITs) and 50 patterns corresponded to orphan strains. The most abundantly represented SITs/lineages were: SIT53/T1 (11.57%), SIT33/LAM3 (9.6%), SIT42/LAM9 (9.39%), SIT50/H3 (5.9%), SIT37/T3 (5%); analysis of the spoligotyping minimum spanning tree as well as spoligoforest were suggestive of a recent expansion of SIT42, SIT50 and SIT37; all of which potentially evolved from SIT53. The most abundantly represented lineages were LAM (40.6%), T (34.1%) and Haarlem (13.5%). LAM was more prevalent in the Santiago (43.6%) and Concepción (44.1%) isolates, rather than the Iquique (29.4%) strains. The proportion of X lineage was appreciably higher in Iquique and Concepción (11.7% in both) as compared to Santiago (1.6%). Global analysis of MTB lineage distribution in Chile versus neighboring countries showed that evolutionary recent lineages (LAM, T and Haarlem) accounted together for 88.2% of isolates in Chile, a pattern which mirrored MTB lineage distribution in neighboring countries (n = 7378 isolates recorded in SITVIT2 database for Peru, Brazil, Paraguay, and Argentina; and published studies), highlighting epidemiological advantage of Euro-American lineages in this region. Finally, we also observed exclusive emergence of patterns SIT4014/X1 and SIT4015 (unknown lineage signature) that have hitherto been found exclusively in Chile, indicating that conditions specific to Chile, along with the unique genetic makeup of the Chilean population, might have allowed for a possible co-evolution leading to the success of these emerging genotypes.

Resistencia primaria a fármacos anti-tuberculosos en Chile 2011-2012 / Primary resistance to anti tuberculosis drugs in Chile 2011-2012

This publication presents the results of the Chilean initial study of resistance to first line anti-tuberculous drugs. The study was carried out between 2011 and 2012 by the National Reference Laboratory of the Institute of Public Health, as part of the Drug Surveillance Resistance in tuberculosis (TB) promoted by the World Health Organization. Methodology: Cross-sectional study performed using cluster sampling, representative of the entire country as recommended by the World Health Organization. Susceptibility testing to isoniazid, rifampicin, streptomycin, ethambutol and pyrazinamide was performed through the proportion method or Wayne's enzymatic method, as appropriate. Results: 594 susceptibility tests were performed, showing an overall level of TB drug resistance of 8.6% and a prevalence of multidrug resistance of 1.3%. Indeed, the study showed a decrease in streptomycin resistance and an increase of isoniazid resistance in both mono-resistance and accumulated resistance compared to previous studies. No cases of mono-resistance to rifampicin were detected. Conclusion: An increased resistance to anti-TB drugs in Chile is observed, which despite being still low, is no less worrisome. Since 2014 the monitoring of drug resistance to TB is universally performed to avoid sub - diagnosis and treat each case according to the susceptibility profile.

Esta publicación presenta los resultados del estudio de resistencia inicial a fármacos anti-tuberculosos de primera línea realizado entre los años 2011 y 2012 en Chile por el Laboratorio de Referencia Nacional del Instituto de Salud Pública, estudio que forma parte de la vigilancia de la fármaco-resistencia en tuberculosis (TBC) promovida por la Organización Mundial de la Salud. Metodología: Estudio transversal realizado mediante un muestreo por conglomerado, representativo de todo el país según recomendaciones de la Organización Mundial de la Salud. Se realizó prueba de susceptibilidad a isoniacida, rifampicina, estreptomicina, etambutol y pirazinamida a través del método de las proporciones o método enzimático de Wayne según corresponda. Resultados: Se realizó test de susceptibilidad a 594 casos de TBC, observándose una resistencia inicial global de 8,6% y una prevalencia de multi-resistencia de 1,3%. Además destaca la caída en la resistencia a estreptomicina y el aumento de la resistencia a isoniacida, tanto en mono-resistencia como en resistencia acumulada para ambos fármacos comparada con los estudios anteriores. No se observaron casos de mono-resistencia a rifampicina. Conclusión. Se observa un aumento de la resistencia a fármacos anti-tuberculosos en Chile la que, a pesar de ser aún baja, no deja de ser preocupante. Desde el año 2014 la vigilancia de fármaco-resistencia para TBC se hace en forma universal, de modo de evitar el sub-diagnóstico y realizar un tratamiento de acuerdo al perfil de susceptibilidad de cada caso.

Detección de mutaciones asociadas a cepas multidrogo resistente de Mycobacterium tuberculosis en Chile / Detection of genes associated with drug resistance in Mycobacterium tuberculosis strains isolated in Chile

Background: The incidence of acquired resistance to antituberculous drugs of Mycobacterium tuberculosis in Chile is approximately 23 percent. Aim: To analyze the mutations associated with drug resistance in drug resistant strains of Mycobacterium tuberculosis. Material and Methods: In 28 drug resistant Mycobacterium tuberculosis strains isolated in Chile, genes leading to drug resistance were studied. DNA was amplifed by polymerase chain reaction (PCR) and sequencing was carried out using the ABI PRISM big dye terminator cycle sequencing ready reaction kit. Results: In rifampicin-resistant strains, the mutations in rpoβ gene were in the codons S531W/L (56 percent), D516Y (16 percent) and D516V (16 percent). The predominant mutation in katG gene was in the codon S315L (73 percent) in isoniazid-resistant strains. The mutation S95T was found in the 71 percent of ciprofoxacin resistant strains. Only one ethambutol resistant strain had the M306I mutation. Three unreported mutations in katG were identifed. Conclusions: Drug resistance associated mutations of Mycobacterium tuberculosis isolated in Chile were similar to those reported abroad.