Results of a New Telemedicine Strategy in Traumatology and Orthopedics.

Introduction:There are few studies showing results about telemedicine strategies in traumatology and orthopedics. We present a new tele-orthopedic strategy started in 2017 at the Reloncaví Health Service in Chile. Our objective was to evaluate its efficiency and impact on the orthopedic surgery specialty care waiting times of the inhabitants of the Calbuco area.Methods:We selected two general practitioners from the Calbuco Hospital who evaluated patients on the waiting list of the specialty. Synchronous connections were made between them and one orthopedic surgeon staff at the referral hospital. Connections were conducted every 2 weeks. Four to eight cases were analyzed in each session.Results:Two hundred ninety-three (n = 293) attentions were performed between June 2017 and July 2018. Highly rural patients constituted 30%. After the first evaluation by the physicians of the Calbuco Hospital, 69.6% (204/293) of the patients' consultations were resolved. The remaining 30.4% (89 patients) were presented to the specialist by telemedicine, from which 69.7% (62) required one or more follow-up connections through tele-orthopedic and 30.3% (27) were referred for on-site assessment by a subspecialist. The waiting times of the referrals decreased on average from 201 to 40 days.Discussion:This new strategy had a significant impact on the population of Calbuco, especially for the rural population. It has been possible to significantly reduce waiting list times and optimize travel times and expenditures. Only a small percentage of patients required on-site attention by a specialist after the videoconference, exhibiting the efficiency of this strategy.

[Educational impact after 10 years of implementation of a portfolio for undergraduate medical students]. / Portafolio en pregrado de Medicina: impacto educacional a 10 años de su implementación.

BACKGROUND: A portfolio is a compilation of academic work that demonstrates student's knowledge, reflection and critical thinking. AIM: To describe the development and implementation of an undergraduate portfolio in the School of Medicine at the Pontificia Universidad Católica de Chile, its temporal evolution and its educational impact after 10 years of experience. MATERIAL AND METHODS: The development and implementation of a portfolio for 4th-year undergraduate medical student was analyzed. Its design, teaching and learning methodologies, results and perceptions of students and teachers were assessed. The educational impact was measured using Kirkpatrick's levels. RESULTS: A total of 1,320 students participated between 2007 and 2017, supported by six teachers and 190 assistant-students. The portfolio included clinical cases, narrative medicine, palliative care and evidence-based medicine (EBM). The overall student's perception was positive, highlighting the development of critical analysis, clinical reasoning and professionalism. The delivery of feedback and learning assessment, allowed students to obtain excellent grades. There were only two cases of plagiarism reported. Fifteen EBM articles and two books with 52 narrative medicine essays were published. The greatest organizational impact of this teaching innovation, was that it evolved to become an established and continuous assessment instrument in 10 consecutive years. CONCLUSIONS: This portfolio is a project with a high educational impact, with a favorable perception by students and tutors, excellent results related to grades, stimulating both scientific writing and reflective practice.

[Nicotinic acid increases cellular transport of high density lipoprotein cholesterol in patients with hypoalphalipoproteinemia]. / El ácido nicotínico aumenta el transporte celular de colesterol de las lipoproteínas de alta densidad en pacientes con hipoalfalipoproteinemia.

BACKGROUND: Plasma high density lipoproteins (HDL) are involved in reverse cholesterol transport mediated by the scavenger receptor class B type I (SR-BI). Nicotinic acid increases HDL cholesterol levels, even though its specific impact on SR-BI dependent-cellular cholesterol transport remains unknown. AIM: To determine the effect of nicotinic acid on HDL particle functionality in cholesterol efflux and uptake mediated by SR-BI in cultured cells in hypoalphalipoproteinemic patients. MATERIAL AND METHODS: In a pilot study, eight patients with low HDL (≤ 40 mg/dL) were treated with extended release nicotinic acid. HDL cholesterol and phospholipid levels, HDL2 and HDL3 fractions and HDL particle sizes were measured at baseline and post-therapy. Before and after nicotinic acid treatment, HDL particles were used for cholesterol transport studies in cells transfected with SR-BI. RESULTS: Nicotinic acid treatment raised total HDL cholesterol and phospholipids, HDL2 levels as well as HDL particle size. Nicotinic acid significantly increased HDL cholesterol efflux and uptake capacity mediated by SR-BI in cultured cells. CONCLUSIONS: Nicotinic acid therapy increases SR-BI-dependent HDL cholesterol transport in cultured cells, establishing a new cellular mechanism by which this lipid-lowering drug appears to modulate HDL metabolism in patients with hypoalphalipoproteinemia.

[Introduction of virtual patients to clinical case portfolios for undergraduate medical students]. / Incorporación de paciente virtual en portafolio de estudiantes de medicina de pregrado.

BACKGROUND: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. AIM: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. MATERIAL AND METHODS: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students’ perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. RESULTS: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains “Student Learning”, “Organization and Evaluation”, “Teaching Methodology” and “Integration”. In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. CONCLUSIONS: The incorporation of virtual patients improved undergraduate students’ perception of CCP.

[Perception of medical students about formative assessments during clinical courses]. / Utilidad de la evaluación formativa en cursos clínicos integrativos en estudiantes de pregrado de medicina.

BACKGROUND: Formative evaluation is a range of formal assessment employed by professors during the teaching process in order to modify curriculum activities, to improve student attainment. For students, it is helpful to evaluate their learning process. Although recommended, it is seldom used. AIM: To evaluate the perception and performance of medical students subjected to formative assessments during an integrative clinical course. MATERIAL AND METHODS: Fourth year medical students that participated in a multiple choice formative assessment, similar to the final exam during 2007 and 2008, responded a survey about the usefulness and quality of such assessment. Student achievement was expressed as the percentage of correct answers of the tests. RESULTS: The formative assessment was answered by 99% of students. In 2007 97% of students considered the experience as excellent or very good and 92% evaluated it as useful or very useful. During 2008 the figures were 89% and 79%. The students outlined that this assessment oriented their study, allowed them to discover their weaknesses and have a perception of the degree of difficulty of the final exam. Over 90% of students that took the formative evaluation, improved their academic achievement. CONCLUSIONS: Formative assessments are well evaluated by medical students and improve their academic achievement.

In-Situ Modification of Nanofiltration Membranes Using Carbon Nanotubes for Water Treatment.

Modification of thin-film composite (TFC) nanofiltration (NF) membranes to increase permeability and improve separation performance remains a significant challenge for water scarcity. This study aimed to enhance the permeability and selectivity of two commercial polyamide (PA) NF membranes, NF90 and NF270, by modifying them with carbon nanotubes (CNTs) using microwave (MW)-assisted in-situ growth. The conducting polymer, polypyrrole (Ppy), and a ferrocene catalyst were used to facilitate the growth process. Chemical and morphological analyses confirmed that the surface of both membranes was modified. The NF270-Ppy-CNT membrane was selected for ion rejection testing due to its superior permeability compared to the NF90-Ppy-CNT. The modified NF270 membrane showed a 14% increase in ion rejection while maintaining constant water permeability. The results demonstrated that it is feasible to attach CNTs to a polymeric surface without compromising its functional properties. The Spliegler-Kedem model was employed to model the rejection and permeate flux of NF270-Ppy-CNT and NF270 membranes, which indicated that diffusive transport contributes to the modification to increase NaCl rejection. The present study provides a promising approach for modifying membranes by in-situ CNT growth to improve their performance in water treatment applications, such as desalination.

Introducing Plant-Based Mediterranean Diet as a Lifestyle Medicine Approach in Latin America: Opportunities Within the Chilean Context.

Latin America is experiencing a significant epidemiological and nutritional transition, with a trend toward higher incidence of food-related chronic diseases. In this context, Lifestyle Medicine (LM) is a growing field focused on assisting individuals in adopting healthy behaviors for the prevention and treatment of these chronic diseases, including, among other pillars, a great emphasis on healthy eating. There is also a growing interest worldwide in environmental sustainability of dietary patterns, with increasing concern about their effects on planetary health. In this context, whole-food, plant-based diets -such as the Mediterranean diet (MD)- have emerged as a solution for both healthier eating and lowering environmental impact. Yet in order to be effective at these goals and achieve a high adherence to any nutritional prescription, the sociocultural reality of the community or population where we aim to practice must also be taken into account. In this review, we specifically highlight the plant-based MD as a LM-contextualized dietary pattern that is adaptable, applicable, and sustainable within the Chilean context and has the potential to address the current trend of chronic diseases in our country.

Evaluación de síntomas neuropsiquiátricos para la detección temprana de trastorno neurocognoscitivo / Evaluation of neuropsychiatry symptoms for the early detection of neurocognitive disorder

RESUMEN INTRODUCCIÓN: El diagnóstico oportuno del trastorno neurocognitivo es de los principales retos en la atención de los trastornos neurocognitivos. Por esto, se han generado estrategias para la detección preclínica de la enfermedad, entre ellas las destinadas a evaluar síntomas neuropsiquiátricos (NPS) como la escala Mild Behavior Impairment - Checklist (MBI-C). MÉTODOS: Inicialmente se realizó una búsqueda en BVSalud, Medline y PsycNet, luego se realizó una búsqueda en bola de nieve. Se incluyeron términos referentes a deterioro comportamental leve (abarcando los NPS en etapas tempranas), deterioro cognitivo leve y términos específicos del MBI-C. RESULTADOS: La presencia de NPS se asocia con un aumento en la incidencia anual de demencia. Al evaluarlos con MBI-C, su puntuación se correlaciona con biomarcadores como una mayor atrofia cortical, la presencia de la proteína β-amiloide, así como disminución en funciones ejecutivas como la capacidad de enfocar la atención y la memoria de trabajo. DISCUSIÓN: Los hallazgos en la literatura sugieren la utilidad de MBI-C como marcador de neurodegeneración en estadios previos a la demencia, esto mediante la evaluación de su capacidad predictiva de forma independiente y al compararla con otros biomarcadores. CONCLUSIONES: MBI-C supone ser un instrumento de fácil aplicabilidad e interpretación, sostenible e incluyente. Sin embargo, quedan vacíos sobre la pertinencia de esta escala, por lo que surge la necesidad de investigar este tema.

ABSTRACT INTRODUCTION: Early diagnosis of neurocognitive disorder is the main challenge of dementia health attention. Therefore, strategies for preclinical detection of the disease have been created, like those intended to evaluate neuropsychiatric symptoms (NPS), like the Mild Behavior Impairment - Checklist (MBI-C). METHODS: Research was performed in BVSalud, Medline, and Psynet. Then a snowball sampling was done. The terms included were mild behavioral impairment (included NPS in initial stages), mild cognitive impairment, and specific terms of MBI-C. RESULTS: The presence of NPS increase the incidence of dementia, with an annual conversion rate of 9%. About MBI-C, the score has been related to biomarkers like worse brain atrophy in patients with Parkinson's Disease and a positive relationship with the presence of B-amyloid protein. Also, Creese and cols. show that mild behavioral impairment (measured by MBI-C) is associated with a faster decrease in attention and working memory. DISCUSSION: MBI-C utility as a neurodegenerative marker has been demonstrated to detect cognitive, neuropsychiatry, and functional symptoms that may precede dementia by evaluating its predictive capacity alone and comparing it to other biomarkers. CONCLUSION: MBI-C is easy to apply and interpret, is sustainable and inclusive. However, there are still gaps in the relevance of the scale, so there is the need to continue investigating this topic.

Anti-inflammatory activity and phenolic profile of propolis from two locations in Región Metropolitana de Santiago, Chile.

ETHNOPHARMACOLOGICAL RELEVANCE: Propolis has long been used as a popular folk medicine due to its wide spectrum of alleged biological and pharmaceutical properties. In Chile, propolis is widely used by folklore medicine as an anti-inflammatory agent; however, this property has not been demonstrated by scientific methods. AIM OF THE STUDY: The objective of this study was to determine the anti-inflammatory activity in vivo and in vitro and to establish the phenolic profile of propolis collected in two localities in Región Metropolitana de Santiago (RM), Chile. MATERIALS AND METHODS: Propolis was collected in the areas of Caleu and Buin, RM Chile. Following that, the samples were unwaxed to obtain the global ethanolic extracts of propolis (EEPs) and, from these, the serial extracts of dichloromethane (EEP-DCMs) and ethanol (EEP-EtOHs). The topic anti-inflammatory effect was evaluated through mice ear edema induced by arachidonic acid (AA) and 12-O-tetradecanoylphorbol-13-acetate (TPA) at a dose of 3 mg/ear. Nitric oxide (NO) measurements were determined spectrophotometrically (Greiss reagent) by the accumulation of nitrite in the medium of macrophages RAW 264.7 stimulated with the lipopolysaccharide (LPS, 1 µg/mL) for 20 h at different concentrations of the EEPs, EEP-DCMs and EEP-EtOHs (6.25-50.00 µg/mL). The content of total phenols and flavonoids were determined through the methods of Folin-Ciocalteau and AlCl3, respectively. The profile of phenolic compounds was determined by HPLC-UV-ESI-MS/MS. RESULTS: The EEP-EtOH (64%) and EEP (59%) of Buin were the most active in the inflammation induced by TPA and AA respectively, being the anti-inflammatory effect stronger than the same Caleu extracts. Regarding the release of NO, all the extracts from the Buin propolis inhibited significantly its release in a concentration-dependent manner, this inhibition was stronger than the extracts from Caleu propolis. CONCLUSIONS: Our research shows for the first time a comparative study of the topical in vivo activity of two Chilean propolis. Both propolis showed in vivo topical anti-inflammatory activity against AA and TPA, the most active was Buin propolis and this difference is due in part to the variations in total phenols and flavonoids content and the phenolic profile. The phenols and flavonoids content of Buin propolis was higher than Caleu propolis. The extracts from Buin propolis result in a lower release of NO.

Identification of phenolic compounds by HPLC-ESI-MS/MS and antioxidant activity from Chilean propolis.

Propolis is a complex hive product produced by honey bees, Apis mellifera. Its composition and biological activities depend on the vegetation where hives are placed. Propolis is often used as a food supplement. The aim of this research is to determine the antioxidant properties in vitro and the phenolic composition of six propolis collected from the region of Santiago of Chile. We obtained the ethanolic extracts dry and wax free (EEPs) and studied their antioxidant properties by FRAP, ORAC-FL, ORAC-PGR and DPPH radical methods. The total phenols were quantified by a spectrophotometric method and 30 phenolic compounds were identified by HPLC-ESI-MS/MS analysis. Curacaví EEP has the highest relative abundance of caffeic acid phenylethyl ester (CAPE) while Buin EEP has the highest relative abundance of caffeic acid benzyl ester and quercetin. Both have the highest antioxidant activity in vitro in all methods used. Our research shows, for the first time, a comparative analysis of the antioxidant activity and phenolic composition of six Chilean propolis. Pinobanksin is the only phenol present in the six samples of propolis so it may be a good candidate for the standardization of propolis ethanolic extracts in the region of Santiago.

Management of Helicobacter pylori infection in Latin America: a Delphi technique-based consensus.

AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature. METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria. RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing. CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.

Portafolio en pregrado de Medicina: impacto educacional a 10 años de su implementación / Educational impact after 10 years of implementation of a portfolio for undergraduate medical students

Background: A portfolio is a compilation of academic work that demonstrates student's knowledge, reflection and critical thinking. Aim: To describe the development and implementation of an undergraduate portfolio in the School of Medicine at the Pontificia Universidad Católica de Chile, its temporal evolution and its educational impact after 10 years of experience. Material and Methods: The development and implementation of a portfolio for 4th-year undergraduate medical student was analyzed. Its design, teaching and learning methodologies, results and perceptions of students and teachers were assessed. The educational impact was measured using Kirkpatrick's levels. Results: A total of 1,320 students participated between 2007 and 2017, supported by six teachers and 190 assistant-students. The portfolio included clinical cases, narrative medicine, palliative care and evidence-based medicine (EBM). The overall student's perception was positive, highlighting the development of critical analysis, clinical reasoning and professionalism. The delivery of feedback and learning assessment, allowed students to obtain excellent grades. There were only two cases of plagiarism reported. Fifteen EBM articles and two books with 52 narrative medicine essays were published. The greatest organizational impact of this teaching innovation, was that it evolved to become an established and continuous assessment instrument in 10 consecutive years. Conclusions: This portfolio is a project with a high educational impact, with a favorable perception by students and tutors, excellent results related to grades, stimulating both scientific writing and reflective practice.

Osteoartritis (artrosis) de rodilla / Knee osteoarthritis (osteoarthrosis)

La artrosis de rodilla (OA) es uno de los principales problemas de salud a nivel mundial debido a su alta prevalencia y costos asociados. Los conocimientos disponibles demuestran que el componente inflamatorio es fundamental en el desarrollo de esta condición, abandonándose el concepto de que la OA es una enfermedad puramente degenerativa. En el presente escrito revisaremos, basándonos en la literatura disponible, la epidemiología y los factores de riesgo involucrados, los nuevos conocimientos fisiopatológicos, el enfrentamiento clínico y los tratamientos disponibles tanto médicos como quirúrgicos de esta condición...

Knee osteoarthritis (OA) is one of the major public health problems worldwide, due to its high prevalence and associated costs. The available knowledge shows that the inflammatory component is critical in the development of this condition, abandoning the concept that OA is only a degenerative disease. A review is presented in this article, based on the available literature, on the epidemiology and risk factors involved, recent knowledge about the pathophysiological and clinical management, and the medical and surgical treatments available for this condition...

El ácido nicotínico aumenta el transporte celular de colesterol de las lipoproteínas de alta densidad en pacientes con hipoalfalipoproteinemia / Nicotinic acid increases cellular transport of high density lipoprotein cholesterol in patients with hypoalphalipoproteinemia

Background: Plasma high density lipoproteins (HDL) are involved in reverse cholesterol transport mediated by the scavenger receptor class B type I (SR-BI). Nicotinic acid increases HDL cholesterol levels, even though its specific impact on SR-BI dependent-cellular cholesterol transport remains unknown. Aim: To determine the effect of nicotinic acid on HDL particle functionality in cholesterol efflux and uptake mediated by SR-BI in cultured cells in hypoalphalipoproteinemic patients. Material and Methods: In a pilot study, eight patients with low HDL (≤ 40 mg/dL) were treated with extended release nicotinic acid. HDL cholesterol and phospholipid levels, HDL2 and HDL3 fractions and HDL particle sizes were measured at baseline and post-therapy. Before and after nicotinic acid treatment, HDL particles were used for cholesterol transport studies in cells transfected with SR-BI. Results: Nicotinic acid treatment raised total HDL cholesterol and phospholipids, HDL2 levels as well as HDL particle size. Nicotinic acid significantly increased HDL cholesterol efflux and uptake capacity mediated by SR-BI in cultured cells. Conclusions: Nicotinic acid therapy increases SR-BI-dependent HDL cholesterol transport in cultured cells, establishing a new cellular mechanism by which this lipid-lowering drug appears to modulate HDL metabolism in patients with hypoalphalipoproteinemia.

Incorporación de paciente virtual en portafolio de estudiantes de medicina de pregrado / Introduction of virtual patients to clinical case portfolios for undergraduate medical students

Background: In 2007, a Clinical-Case-Portfolio (CCP) was introduced as a new assessment instrument for fourth grade undergraduate medical students. Since then, several changes have been implemented such as reduction on the number of clinical cases, peer review and the introduction of virtual patient to the portfolio. Aim: To describe the virtual patient model incorporated to the CCP and assess the perception of this change and its effects on the performance of undergraduate students. Material and Methods: Virtual patients were implemented based on prototype clinical cases with specific syndromes. Students’ perceptions about CCP before and after the introduction of virtual patients were evaluated using a validated questionnaire that was answered voluntarily and anonymously. Results: Overall perception of CCP significantly improved after the incorporation of virtual patients (97.1 ± 24.9 and 111.3 ± 25.7 points; 57.8 and 66.2% respectively). The same improvements were observed for the domains “Student Learning”, “Organization and Evaluation”, “Teaching Methodology” and “Integration”. In both years, students obtained high grades in CCP evaluations. However CCP grades were not significantly correlated with integrated final grades. Conclusions: The incorporation of virtual patients improved undergraduate students’ perception of CCP.

Utilidad de la evaluación formativa en cursos clínicos integrativos en estudiantes de pregrado de medicina / Perception of medical students about formative assessments during clinical courses

Background: Formative evaluation is a range of formal assessment employed by professors during the teaching process in order to modify curriculum activities, to improve student attainment. For students, it is helpful to evaluate their learning process. Although recommended, it is seldom used. Aim: To evaluate the perception and performance of medical students subjected to formative assessments during an integrative clinical course. Material and Methods: Fourth year medical students that participated in a multiple choice formative assessment, similar to the final exam during 2007 and 2008, responded a survey about the usefulness and quality of such assessment. Student achievement was expressed as the percentage of correct answers of the tests. Results: The formative assessment was answered by 99% of students. In 2007 97% of students considered the experience as excellent or very good and 92% evaluated it as useful or very useful. During 2008 the figures were 89% and 79%. The students outlined that this assessment oriented their study, allowed them to discover their weaknesses and have a perception of the degree of difficulty of the final exam. Over 90% of students that took the formative evaluation, improved their academic achievement. Conclusions: Formative assessments are well evaluated by medical students and improve their academic achievement.

Análisis de concordancia de cuatro pruebas rápidas para la detección de influenza A en Bogotá / Analysis of concordance of four rapid diagnostic tests for influenza A detection in Bogota-Colombia

La rapidez, eficacia y oportunidad del diagnóstico de influenza facilita el manejo de casos confirmados a nivel terapéutico más aun considerándose el estado actual del virus pandémico H1N1/2009. Objetivo: Analizar la concordancia de cuatro pruebas rápidas para la detección de Influenza A en Bogotá. Métodos: En este estudio descriptivo de corte transversal fueron comparadas cuatro pruebas rápidas para la detección de Influenza A (Quick Vue Influenza A+B; Directigen Ez Flu A+B®; SD Bioline Influenza Antigen® y Clearview Exact Influenza A and B®) en un grupo de 57 hisopados nasofaríngeos de pacientes sospechosos del virus pandémico H1N1/2009, los cuales fueron analizados previamente por PCR en tiempo real y clasificados como positivos o negativos para Influenza A. Resultados: El comportamiento de las pruebas rápidas valorado por su concordancia global con la prueba de referencia fluctuó entre 68,19% y 74,47%, sin evidencias de diferencias estadísticamente significativa entre ellas (c2=0,35; p=0,95). Tampoco se encontró un comportamiento diferencial estadísticamente significativo al valorar la proporción de concordancia entre los positivos de cada una de las pruebas rápidas con la prueba de referencia. Conclusión: Existen varios trabajos a favor y en contra de las pruebas rápidas para influenza, y algunos destacan su baja sensibilidad y especificidad comparadas con otras metodologías, como inmunofluorescencia directa, cultivo viral y RT-PCR. Sin embargo,ante la emergencia que actualmente se vive por la pandemia viral H1N1/2009, diferentes estrategias de vigilancia en salud pública, incluidas los estudios centinela y de conglomerados, pudieran ser implementados y las pruebas rápidas influenza (sin importar la casa comercial) serían útiles por sus características operativas, bajo costo y la posibilidad de lograr mayores coberturas de identificación de casos nuevos, descongestión de servicio y ajuste rápido de medidas en salud pública.

Rapidity, effectiveness and opportunity of influenza diagnosis make easy confirmed cases handling at therapeutic level most of all considering actual state of pandemic virus A H1N1/2009. Objective: To analyze agreement of four quick tests for Influenza A detection of in Bogotá. Methods: In a cross sectional fashion it was compared four quick tests designed for influenza detection (Quick Vue Influenza A + B; Directigen Ez Flu A + B®; SD Bioline Influenza Antigen® and Clearview Exact Influenza A and B®) in 57 nasopharynxeal hyssoped examples of suspicious patients of pandemic A H1N1/2009 virus, all of them were previously analyzed by real-time PCR and classified as positive for that virus. Results: Behavior of fast tests valued by its global agreement against test of reference fluctuated between 68.19% and 74,47%, without significant statistical differences among them (p=0,95). Neither significant statistical differences were found upon valuing proportion of agreement among positives each one of fast tests with reference test. Conclusions: There are some works on behalf or against of influenza rapid tests, and some of them emphasizes their low sensibility and specificity against other techniques, like direct inmunofluorescence inmunofluorescence, viral culture and RT-PCR. Nevertheless, in order to face the actual viral AH1N1/2009 pandemic, different strategies of public health surviellance, (including sentinel and conglomerate studies), could be implemented. Influenze Rapid tests (making exclusion of trade mark) would be serviceable by their operative characteristics, low cost and high possibility of identify new cases and by that way, it would possible emergence services decongestion and fast adjustment of measures in Public Health.

Efecto de la administración de triiodotironina y glucagón sobre la expresión hepática del receptor de lipoproteínas de alta densidad y el metabolismo del colesterol en el ratón / Effect of triiodothyronine (T3) and glucagon on hepatic expression of SR-BI and lipoprotein cholesterol metabolism in mice

Introducción: El receptor scavenger clase B tipo I (SR-BI) es un elemento clave en el metabolismo de las HDL, donde su expresión ejerce un importante efecto anti-aterogénico controlando la fase hepática del transporte reverso de colesterol. Así, el estudio de la modulación de la expresión de SR-BI permitiría el desarrollo de nuevas alternativas farmacológicas para el tratamiento de la ateroesclerosis. Objetivo: La meta de nuestro estudio fue determinar el efecto de la triiodotironina (T3) y el glucagón sobre el metabolismo del colesterol HDL y la expresión hepática de SR-BI en el ratón, evaluando simultáneamente su impacto sobre el colesterol total y lipoproteico plasmático y la secreción biliar de colesterol. Métodos: Se utilizaron ratones C57BL/6 tratados con T3 (30 nmol/kg/día) o glucagón (80 µg/día) más los respectivos grupos controles. Después del tratamiento, los animales se anestesiaron para recolección de bilis, plasma y tejido hepático. Los niveles totales de colesterol plasmático y biliar fueron medidos por métodos enzimáticos. El colesterol lipoproteico plasmático se evaluó por fraccionamiento cromatográfico del plasma y medición enzimática del colesterol en cada fracción. La expresión hepática de SR-BI se cuantificó mediante western blot. Resultados: El uso de T3 o glucagón disminuyeron significativamente el colesterol plasmático total y aumentaron el colesterol biliar con respecto al grupo control correspondiente. Las fracciones de colesterol VLDL, LDL y HDL disminuyeron en ambos grupos tratados, con un mayor efecto observado en la fracción HDL. La administración de ambas hormonas aumentaron significativamente los niveles hepáticos de SR-BI. Conclusión: Los resultados establecen que T3 y glucagón disminuyen el colesterol plasmático, predominantemente de tipo HDL, y aumentan la secreción de colesterol biliar en el ratón, probablemente como consecuencia del incremento en la expresión hepática...

Introduction: The scavenger receptor class B type I (SR-BI) plays a key role in the metabolism of high-density lipoprotein (HDL) cholesterol. Its expression has an important anti-atherogenic effect by controlling the hepatic phase of the reverse cholesterol transport pathway in vivo. Thus, the study of the modulation of SR-BI expression may allow the development of new pharmacologic approaches for treatment of atherosclerotic cardiovascular disease. Objective: The goal of this study was to determine the effect of triiodothyronine (T3) and glucagon on HDL metabolism and hepatic expression of SR-BI in mice, evaluating also the impact in total and lipoprotein cholesterol as well as biliary cholesterol secretion. Methods: C57BL/6 mice were treated with T3 (30 nmol/kg/día) or glucagon (80 µg/día) in comparison to appropriate control groups. After treatment, bile, plasma and hepatic tissue were collected for analysis. Total plasma and biliary cholesterol levels were measured by enzymatic methods. Lipoprotein cholesterol was also measured enzymatically after chromatographic separation of plasma samples. The hepatic expression of SR-BI protein was quantified by western blotting. Results: The use of T3 or glucagon significantly decreased total plasma cholesterol levels and increased of biliary cholesterol concentrations compared to control groups. Levels of VLDL, LDL and HDL cholesterol were reduced in both treatment groups, with a more important effect observed in the HDL fraction. Both treatments increased hepatic SR-BI protein levels. Conclusions: These results show that T3 and glucagon decrease plasma cholesterol levels, particularly in HDL, and increase biliary cholesterol secretion in mice, probably as a consecuence of higher hepatic expression of SR-BI, which may have led to facilitated HDL cholesterol transport from plasma into bile.