[Assessment of adherence to antihypertensive therapy]. / Prevalencia y determinantes de adherencia a terapia antihipertensiva en pacientes de la Región Metropolitana.

BACKGROUND: Lack of adherence with medications is the main cause of antihypertensive treatment failure. AIM: To assess adherence to antihypertensive drugs and its determinants. MATERIAL AND METHODS: The Morinsky-Green questionnaire to determine treatment adherence was applied to 310 hypertensive patients from primary care centers, aged 60 ± 10 years (65% females) in treatment for 4 ± 1 months. Socio-demographic features, use of medications and quality of life using EQ5D questionnaire were also assessed. RESULTS: Twenty percent of patients were diabetic and 19% were smokers. Fifty four percent were adherent to therapy. A higher age and being unemployed were associated with a higher compliance. The main reasons to justify the lack of adherence were forgetting to take the pills in 67% and adverse effects in 10%. Only diastolic pressure was lower in adherent patients, compared with their non-adherent counterparts (78 ± 12 and 81 ± 17 mmHg, respectively p < 0.01). CONCLUSIONS: Only half of hypertensive patients comply with their antihypertensive therapy.

[Cryptosporidium parvum infection in a pregnant immunocompetent woman with occupational risk]. / Infección por Cryptosporidium parvum en una mujer embarazada, inmunocompetente, con riesgo ocupacional.

Cryptosporidioses is a parasitic zoonoses generated by diverse Cryptosporidium species. This coccidiosis affects multiple vertebrate species, including human beings. In Chile, as it happens in other countries, cryptosporidioses is a low frequency infection in immunocompetent individuals, acquiring a big relevance in immunocompromised ones. We present the following case: a recently graduated student from Veterinary medical school, with a 20 week pregnancy, living in "Laguna Verde" area in the Region of Valparaiso and who was infected with Cryptosporidium sp. Etiologic diagnosis was made by Ziehl Neelsen, and nested PCR followed by PCR product sequencing. During the same period, the infection was detected in her cats which were asymptomatic. In all of them, her and the cats, the species identified was Cryptosporidium parvum. Her husband and her other pets were all asymptomatic and non infected. This is the first report of a possible cryptosporidioses transmission between humans and cat.

Evidence of increased anthropogenic emissions of platinum: time-series analysis of mussels (1991-2011) of an urban beach.

The anthropogenic emissions of Pt to the environment have increased significantly over the past decades, especially after the introduction of the catalytic converters in motor vehicles. In order to check whether this is affecting the levels of this trace metal on living organisms, time-series analysis of freeze-dried soft tissue material of wild mussels (Mytilus galloprovincialis) covering the period from 1991 to 2001 and collected at an urban beach in the city of Vigo (NW Iberian Peninsula) was conducted. Concentrations ranged from 0.30 to 0.68 ng g(-1) with an average concentration of 0.47 ± 0.10 ng g(-1) (n=21); these concentrations were higher than those obtained for samples collected at a control location away from anthropogenic pressure (0.31 ± 0.10 ng g(-1); n=5). Platinum concentrations followed a statistically significant temporal trend (at the 0.020 level), and the excess of Pt in mussels over the 1991-2011 period compared to the control location were correlated with the European Pt autocatalyst demand (p=0.0006) and, especially, the car sales in Spain (p=0.0001). A bioaccumulation factor of ~5·10(3) was derived, which is greater than those previously calculated for Pt from exposure experiments, but 1-2 orders of magnitude lower than other trace elements (e.g. Zn, Cu, Pb, Cd).

Evaluation of the contamination of platinum in estuarine and coastal sediments (Tagus Estuary and Prodelta, Portugal).

Platinum contamination in estuarine and coastal sediments has been evaluated in three cores collected from the Tagus Estuary and Prodelta shelf sediments. Elevated concentrations, up to 25-fold enrichment compared to background values, were found in the upper layers of the estuarine sediments. The degree of Pt enrichment in the estuarine sediments varied depending on the proximity to vehicular traffic sources, with a maximum concentration of 9.5 ng g(-1). A considerable decrease of Pt concentrations with depth indicated the absence of significant contamination before the introduction of catalytic converters in automobiles. Platinum distribution in the Tagus Prodelta shelf sediment core showed no surface enrichment; instead a sub-surface maximum at the base of the mixed layer suggested the possibility of post-depositional mobility, thereby blurring the traffic-borne contamination signature in coastal sediments.

Prevalencia y determinantes de adherencia a terapia antihipertensiva en pacientes de la Región Metropolitana / Assessment of adherence to antihypertensive therapy

Background: Lack of adherence with medications is the main cause of antihypertensive treatment failure. Aim: To assess adherence to antihypertensive drugs and its determinants. Material and Methods: The Morinsky-Green questionnaire to determine treatment adherence was applied to 310 hypertensive patients from primary care centers, aged 60 ± 10 years (65% females) in treatment for 4 ± 1 months. Socio-demographic features, use of medications and quality of life using EQ5D questionnaire were also assessed. Results: Twenty percent of patients were diabetic and 19% were smokers. Fifty four percent were adherent to therapy. A higher age and being unemployed were associated with a higher compliance. The main reasons to justify the lack of adherence were forgetting to take the pills in 67% and adverse effects in 10%. Only diastolic pressure was lower in adherent patients, compared with their non-adherent counterparts (78 ± 12 and 81 ± 17 mmHg, respectively p < 0.01). Conclusions: Only half of hypertensive patients comply with their antihypertensive therapy.

[Metal microchanelled fine-toothed comb use in the diagnosis of pediculosis]. / Utilidade do pente metálico com dentes microcanaliculados no diagnóstico da pediculose.

BACKGROUND: Methods for the diagnosis of Pediculus humanus var. capitis are controversial and most studies are based on direct visual exam. OBJECTIVE: The objective of this study was to compare the diagnosis efficacy of both direct visual exam and the use of a metal microchanelled fine-toothed comb. METHODS: 946 children and teenagers 4 to 19 years of age were examined. Each individual's hair was examined twice to determine whether there was infestation by lice or nits, through direct visual exam and the use of a metal microchanelled fine-toothed comb. RESULTS: The visual diagnosis detected infestation in 30.7% of the cases, while the metal comb detected infestation in 51.5%. Females were the most affected. The forms of parasites detected through direct visual exam were: only lice (adults and/or nymphs) 1.4%, only live nits 64.8% and live nits and lice, 33.8%; with the metal comb the percentages were 6.4%, 23.6% and 70%, respectively. The average time to find a louse was 57 seconds with the fine-toothed comb and 116.4 seconds through the direct visual exam. CONCLUSIONS: Diagnosis with the microchanelled fine-toothed comb is twice as fast and 3.6 times more efficient than through direct visual exam.The direct visual exam detects non-active, past infestations, and underestimates active ones.

[Auricular myiasis cause by Cochliomyia hominivorax (Diptera: Calliphoridae) (Coquerel, 1858)]. / Miasis auricular por Cochliomyia hominivorax (Diptera: Calliphoridae) (Coquerel, 1858).

We report a 37 years old male, coming from Paraguay, who consulted for tinnitus, hearing loss, foreign body sensation and pain in the left ear. He informed that a fly entered into his external auditive channel, five days before consulting. We observed the destruction of the tympanic membrane and 22 live larvae were extracted. Following the larval extraction, these injuries evolved to complete resolution. Larvae were identified as pertaining to the genus Cochliomyia hominivorax.

Utilidade do pente metálico com dentes microcanaliculados no diagnóstico da pediculose / Metal microchanelled fine-toothed comb use in the diagnosis of pediculosis

Fundamentos: Os métodos para diagnosticar Pediculus humanus var. capitis são controvertidos e a maioria dos estudos tem usado o exame visual direto. Objetivos: O objetivo deste estudo foi comparar a eficácia no diagnóstico do exame visual direto em contraposição ao uso do pente metálico de aço com dentes microcanaliculados. Métodos: Investigaram-se 946 crianças e adolescentes de quatro a 19 anos. O cabelo de cada criança foi examinado duas vezes, para detectar infestação pelos diferentes estádios, por meio da observação visual direta e com o pente metálico. Resultados: O diagnóstico visual apontou infestação em 30,7 por cento dos casos, enquanto que o pente metálico indicou um resultado de 51,5 por cento. O sexo feminino foi o mais acometido, de acordo com ambos os métodos. As formas parasitárias detectadas com o exame visual direto foram: somente piolhos (adultos e/ou ninfas); 1,4 por cento; somente lêndeas vivas, 64,8 por cento; e lêndeas vivas mais piolhos, 33,8 por cento; com o pente metálico, foram 6,4 por cento, 23,6 por cento e 70 por cento, respectivamente. A média de tempo para descobrir um piolho foi de 57 segundos com o pente metálico e de 116,4 segundos com a observação visual direta. Conclusões: O diagnóstico é duas vezes mais rápido e 3,6 vezes mais eficiente com o pente metálico microcanaliculado. O método visual leva a uma subestimação das infestações ativas e revela as passadas não ativas.

Background: Methods for the diagnosis of Pediculus humanus var. capitis are controversial and most studies are based on direct visual exam. Objective: The objective of this study was to compare the diagnosis efficacy of both direct visual exam and the use of a metal microchanelled fine-toothed comb. Methods: 946 children and teenagers 4 to 19 years of age were examined. Each individual’s hair was examined twice to determine whether there was infestation by lice or nits, through direct visual exam and the use of a metal microchanelled fine-toothed comb. Results: The visual diagnosis detected infestation in 30.7 percent of the cases, while the metal comb detected infestation in 51.5 percent. Females were the most affected. The forms of parasites detected through direct visual exam were: only lice (adults and/or nymphs) 1.4 percent, only live nits 64.8 percent and live nits and lice, 33.8 percent; with the metal comb the percentages were 6.4 percent, 23.6 percent and 70 percent, respectively. The average time to find a louse was 57 seconds with the fine-toothed comb and 116.4 seconds through the direct visual exam. Conclusions: Diagnosis with the microchanelled fine-toothed comb is twice as fast and 3.6 times more efficient than through direct visual exam.The direct visual exam detects non-active, past infestations, and underestimates active ones.

Malaria por Plasmodium falciparum en el servicio de medicina del Hospital San Camilo de San Felipe / Malaria by Plasmodium falciparum in the medicine service of San Camilo Hospital of San Felipe

Paciente de 36 años (camionero), sin antecedentes mórbidos de importancia, que luego de un viaje por Brasil, inicia cuadro de malestar general, poliartralgia y gran decaimiento. Consultando a la semana por sensación febril e ictericia en el Hospital de los Andes. Se constata fiebre, compromiso del estado general, ictericia, destacando en los exámenes de laboratorio: elevación de las transaminasas, fosfatasas alcalinas, hiperbilirrubinemia y disminución de hematocrito y plaquetas. Se lo hospitaliza con el diagnóstico de Síndrome Febril Ictérico Obs: Hepatitis viral, malaria o fiebre amarilla. Evoluciona con caída de su hematocrito y plaquetas, manteniéndose las pruebas hepáticas alteradas. Se realizan exámenes directos e indirectos para diagnóstico de Malaria, confirmándose con la visualización de trofozoítos de Plasmodium falciparum e indirectamente por detección en sangre de pLDH mediante optiMAL IT kit. Se inicia terapia con Cloroquina, con buena respuesta sintomática, con recuperación de plaquetas, mantención del Hematocrito y normalización de las pruebas hepáticas. La malaria por P. falciparum se describe como aquella que ocasiona las formas más graves y con compromiso hepático. Se destaca que ante la facilidad de transporte de personas de áreas endémicas, se hace más factible la aparición de casos en áreas no endémicas como en este servicio. Debido al riesgo, se debe estar preparado para la toma de muestras adecuadas que permitan la certificación en centros que como en éste, llegan pacientes extranjeros. El diagnóstico del paciente se hizo de forma expedita debido a una buena anamnesis, la que orientó claramente al diagnóstico de certeza.

Cryptosporidiosis en la V región, Chile: I estudio en pacientes con síndromes diarreicos, 1985-1987 / Human cryptosporidiosis in the 5th. region of Chile: I study in patients with diarrheic syndromes, 1985-1987

Mediante examen de un frotis fecal teñido con Ziehl-Neelsen se estudió la frecuencia de infección por Cryptosporidium sp en 512 pacientes con síndromes diarreicos, tanto agudos, como de evolución tórpida y crónicos, de la V Región, Chile. De estos casos, 109 eran pacientes hospitalizados y 403 ambulatorios, de ambos sexos y diversa edad. En todos ellos también se practicó examen coproparasitológico corriente por el método de Telemann Modificado. Se encontró un total de 20 pacientes positivos a Cryptosporidium sp (3,9%), con una frecuencia general de 10% entre los hospitalizados y de 2,2% entre los ambulatorios, diferencia que es estadísticamente significativa. De los 20 casos, 19 (95%) fueron comprobados en niños, especialmente entre lactantes menores (11,8%) y mayores (6,8%), o en preescolares (2,7%). La mayor frecuencia de infección estuvo relacionada con cuadros diarreicos agudos o de evolución tórpida (10,9% y 10,8%, respectivamente, en los pacientes hospitalizados). En dos casos se observó concomitancia de infección con Giardia lamblia y en uno fueron también encontrados quistes de Entamoeba coli, todos ellos en pacientes ambulatorios

Echinococcus granulosus: evaluation of protoscolicidal activity of several substances

Surgical treatment of hydatid disease requires the use of protoscolicidal substances to prevent secondary infection of the patients. The most commonly used substance in Chile is Na C1 (20 por cento) due to its low frequency od adverse effects. We tested the protoscolicidal activity of two benzimidazole drugs, albendazole and mebendazole, currently used for chemotherapy of hydatidosis disease in humans. Bovine and human protoscolices were used in the test. Vitality of protoscolices was evaluated by Evans blue vital staining. Isolated protoscolices were exposed to hypertonic NaC1 (20 por cento) solution for the same time. In protoscolices obtained from cattle, mebendazole at 300 ug/ml produced the highest mortality (72.5 por cento), followed by albendozole at 120 ug/ml with a mortality of 69.5 por cento...

Modificaciones al método de sedimentación por gravedad en el diagnóstico coprológico de la fasciolasis humana / Modification to the gravity sedimentation method for the coprological diagnosis of human fasciolasis

Con el fin de lograr un diagnóstico coprológico más rápido y fácial en la infección humana por F. hepática se modificó la base de lectura del método de Sedimentación por Gravedad (SG), empleando vasos de precipitados para la sedimentación y examinándolo en placas de Petri bajo lupa estereoscópica. Se evaluó su eficiencia en 15 series de 6 muestras fecales , obtenidas en días seguidos de pacientes conocidos, y comparando con los resultados que en iguales muestras daban los métodos de Telemann modificado(TM) y el de SG habitual. El rendimiento general fué de 40% para el TM y de 100% para el SG y la modificación propuesta, con lo cual se descartó en TM como método diagnóstico confiable en ésta infección. Profundizando la comparación entre los métodos SG y la modificación, se pudo establecer que ésta última permite un hallazgo más fácil y rápido y con menos número de huevos presentes en las muestras, con una eficiencia final de lecturas positivas/lecturas realizadas de 92,2% para la modificación y de 20,6% para el SG clásico. Se estudió experimentalmente la sensibilidad de la modificación agregando cantidades progresivas de huevos del parásito (de 5 en 5) a 10 ml de heces negativas, de las cuales se efectuaron 10 lecturas sucesivas, comprobándose que con 15 huevos o más todas las lecturas resultaban positivas. Sobre la base de éstos hallazgos se recomienda aplicar la modificación ensayada al método SG para el diagnóstico coprológico de la fascioliasis humana. Para éste método SG modificado se propone el nombre de Sedimentación Rápida. Adicionalmente los resultados obtenidos demuestran que en la fase de estado de ésta infección en el hombre , los huevos del parásito son expulsados a diario y en alto número por las heces

Entero y ectoparasitosis en niños de la V Región, Chile: estudio en el internado "San José", La Capilla, Algarrobo, 1986 / Intestinal and ectoparasitic infections in children of the fifth Region of Chile

Se presentan los resultados de una encuesta entero y ectoparasitaria con el objeto de ampliar el conocimiento de la situación existente en la V Región, Chile. Se encuestaron 128 niños mediante estudio coproparasitario y Test de Graham seriados y por diagnóstico directo de sarna y pediculosis capitis. Los parásitos más frecuentes fueron E. Vermicularis (44,8%) y G. Lamblia (20,7%), no encontrándose A. lumbricoides ni E. histolytica en dichos alumnos. El protozoo comensal más frecuente fué E. nana (32,7%). Cryptosporidium sp se presentó con baja frecuencia (4,1%), porcentaje similar al encontrado en pacientes con diarrea de Valparaíso. Sarna y pediculosis aparecieron con baja frecuencia en los alumnos del Internado estudiado: 9,4% y 0,8%, respectivamente