Biologic and genetic characteristics of Toxoplasma gondii isolates in free-range chickens from Nicaragua, Central America.

The prevalence of Toxoplasma gondii in free-ranging chickens is a good indicator of the prevalence of T. gondii oocysts in the soil because chickens feed from the ground. The prevalence of T. gondii in 98 free-range chickens (Gallus domesticus) from Nicragua was determined. Antibodies to T. gondii were assayed by the modified agglutination test (MAT), and found in 84 (85.7%) of 98 chickens with titers of 1:5 in 10, 1:10 in eight, 1:20 in seven, 1:40 in nine, 1:80 in 11, 1:160 in one, 1:200 in 27, 1:400 in six, 1:800 four, and 1:3200 in one bird. Hearts and brains of 32 chickens with titers of 1:10 or less were pooled and fed to three T. gondii-free cats. Hearts and brains of 66 chickens with titers of 1:20 or higher were bioassayed in mice. Feces of cats were examined for oocysts. The cat fed tissues from eight chickens with titers of 1:10 shed T. gondii oocysts. The two cats fed tissues of 24 chickens with titers of 1:5 or less did not shed oocysts. T. gondii was isolated by bioassay in mice from 47 chickens with MAT titers of 1:20 or higher. All infected mice from six isolates died of toxoplasmosis. Overall, 41 of 170 (24.1%) mice that became infected after inoculation with chicken tissues died of toxoplasmosis. Genotyping of these 48 isolates (47 from mice and 1 from pooled tissues) using polymorphisms at the loci SAG1, SAG2, SAG3, BTUB and GRA6 revealed eight genotypes. Six isolates had Type I alleles, three isolate had Type II alleles and six isolates had Type III alleles at all loci. Four isolates had mixed infections. Two isolates have a unique allele at SAG1 locus and combination of I and III alleles at other loci. The rest 27 isolates contained the combination of Type I and III alleles and were divided into four genotypes. More than one genotypes were often isolated in chickens from the same household, indicating multiple genotypes were circulating in the same environment. This may explain the high frequency of mixed infections observed. High rate of mixed infection in intermediate hosts such as chickens may facilitate genetic exchange between different parasite lineages in definitive feline hosts. This is the first report of genetic characterization of T. gondii isolates from Nicragua, Central America.

Presenilin-1-associated abnormalities in regional cerebral perfusion.

OBJECTIVE: To investigate the influence of the presenilin-1 gene (PS-1) mutation on regional cerebral perfusion, SPECT was evaluated in 57 individuals. The subjects were members of a large pedigree from Colombia, South America, many of whom carry a PS-1 mutation for early-onset AD. METHODS: Members of this large kindred who were cognitively normal and did not carry the PS-1 mutation (n = 23) were compared with subjects who were carriers of the mutation but were asymptomatic (n = 18) and with individuals with the mutation and a clinical diagnosis of AD (n = 16). Cerebral perfusion was measured in each subject using hexamethylpropyleneamine oxime SPECT. The data were analyzed in two ways: 1) Mean cerebral perfusion in each of 4320 voxels in the brain was compared among the groups using t-tests (t-maps); and 2) each individual received a weighted score on 20 vectors (factors), based on a large normative sample (n = 200), using a method known as singular value decomposition (SVD). RESULTS: Based on t-maps, subjects with the PS-1 mutation who were asymptomatic demonstrated reduced perfusion in comparison with the normal control subjects in the hippocampal complex, anterior and posterior cingulate, posterior parietal lobe, and anterior frontal lobe. The AD patients demonstrated decreased perfusion in the posterior parietal and superior frontal cortex in comparison with the normal control subjects. Discriminant function analysis of the vector scores derived from SVD (adjusted for age and gender) accurately discriminated 86% of the subjects in the three groups (p < 0.0005). CONCLUSION: Regional cerebral perfusion abnormalities based on SPECT are detectable before development of the clinical symptoms of AD in carriers of the PS-1 mutation.

Localization of the response elements of a gene induced by intermittent growth hormone stimulation.

Three regions required for the expression of a mouse major urinary protein (MUP) transgene were identified by a deletion analysis. One of these was located upstream of the cap site between -2139 and -1800, another was the proximal promoter region downstream of -324 and the third lay within the 338 nucleotide intron 1. Both the proximal promoter and intron 1 are involved in sexually dimorphic expression of the transgene (male/female ratio 20), which is dictated by the different temporal profiles of circulating GH in the two sexes. The data also indicated that the region between exons 3 and 7 may contribute to full expression in males and that a region between -718 and -324 may contribute towards the low expression level that obtains in females, but compared with the three principal regions the effects of these regions are relatively minor. We propose (1) that full expression of the transgene requires the co-operation of transcription factors bindings to the three principal regions and (2) that the difference in expression between the sexes relates to interactions between transcription factors bound to the proximal promoter and to sites in intron 1. Our results complement earlier in vitro footprinting and gel-retardation studies of the homologous rat apha 2u-globulin genes. These identified a number of response elements, including putative C/EBP and AP1 sites in the proximal promoter and intron 1 respectively and three putative psi NF-1 sites, two in the proximal promoter and one in intron 1, but proof of the functionality of these sites in regulating transcription was lacking. The proximal promoter also contained a 34 nucleotide sequence that has 70% identity with the SPI GH response element.

An association study of bipolar mood disorder (type I) with the 5-HTTLPR serotonin transporter polymorphism in a human population isolate from Colombia.

The short variant of a functional length polymorphism in the promoter region of the serotonin transporter has been associated with several behavioural and psychiatric traits, including bipolar mood disorder. The same short allele has also been implicated as a modifier of the bipolar phenotype. Here we evaluate the etiologic/modifier role of this polymorphism in a case (N=103) / control (N=112) sample for bipolar mood disorder (type I) collected from an isolated South American population. We did not detect an association between bipolar disorder and the 5-HTT promoter polymorphism in this sample. However, an excess of the short allele was seen in younger cases and in cases with psychotic symptoms. When combined with data from the literature, the increased frequency of the short allele in patients with psychotic symptoms was statistically significant.

Ovicidal fungi in soils of Cuba.

Thirty-six strains of ovicidal fungi were isolated from 122 investigated soil samples collected in Cuba. The isolated strains belong to 8 genera, 2 strains consist of sterile mycelium only. Most of the strains belong to the genus Fusarium (4 species, 1 undetermined strain), the remaining ones to Mortierella (3 species and 6 undetermined strains), Humicola (2 species), Paecilomyces (2 species) and Penicillium (2 species). The genera Verticillium, Gliocladium and Cunninghamella were represented by one species each. A majority of isolated strains exhibited a high to very high ovicidal activity immediately after isolation; strains with a lower initial activity occurred only exceptionally. The high ovicidal activity has been preserved till now in the following five strains: Paecilomyces marquandii (2 strains), Fusarium solani f. spec. radicicola (1 strain), Mortierella sp. (1 strain) and the sterile mycelium (1 strain).

[Antiochian genealogies in which idiopathic epilepsy presents familial conglomeration. Simulations of power for the detection of genetic linkage]. / Genealogías antioqueñas en las que la epilepsia idiopática presenta conglomeración familiar. Simulaciones de poder para detectar ligamiento genético.

OBJECTIVE AND METHODS: We have analyzed a set of multigenerational extended pedigrees ascertained from affected cases of idiopathic epilepsy in the Antioquian Neurologic Institute. All pedigrees show familial aggregation of several forms of non myoclonic idiopathic epilepsy. In a recent paper, we have demonstrated that generalized idiopathic epilepsy of the awakening type is better explained by the existence of a major gene. In this paper, we have explored by simulation techniques the usefulness of the bigger pedigrees for linkage analysis. By using simlink and taking into account the parameters of the major gene, we have estimated that total power of three families is approximately 100 million times favoring the linkage detection. RESULTS AND CONCLUSIONS: These analyses suggest that the major gene accounting by the susceptibility to develop generalized idiopathic epilepsy of the awakening type could be localized by typifying affected families belonging to the Paisa community from Antioquia, Colombia (Acta Neurol Colomb 1997; 13: 69-75).

Validación de escala MinCir de estudios de pronóstico / Methodological quality in prognostic papers (scale MinCir Pr)

Introduction: Our team reported the development of a scale for assessing methodological quality in prognostic papers (scale MinCir Pr). The aim of this paper is to report the process of validation of scale MinCir Pr. Material and Methods: We reviewed 121 papers about prognosis. Score was performed according to the scale MinCir Pr and level of evidence. In addition we recorded the number of publications of the author. For the construct validity of the measurement was made through the technique known extreme groups, which claims that the evaluations differ regarding the critical attribute. To this end, we used the level of evidence items 2 and 4, waiting for a difference in scale scores of articles published at the ends of the score. Results: For validation of extreme groups we compare the performance of the scale in relation to the level of evidence 2 and 4, since in these groups had more papers (55 and 48 respectively). The average score of the scale in papers with level of evidence 2 was 82.21 +/- 13.79 compared with the score in papers with level of evidence 4 which was 64.97 +/- 17.10 (p = 0.000). Conclusion: We performed the validity of the scale builder MinCir Pr using the technique known extreme groups.

Introducción: Nuestro equipo de trabajo reportó el desarrollo de una escala de evaluación de calidad metodológica de estudios de pronóstico (escala MinCir Pr). El objetivo del presente trabajo es reportar el proceso de validación de la escala MinCir Pr. Material y Método: Se revisaron 121 estudios de pronóstico. Se realizó la puntuación de los trabajos según la escala MinCir Pr y según el nivel de evidencia. Además se registró el número de publicaciones del autor. Para la validez de constructo se realizó la medición por medio de la técnica de grupos extremos conocidos, que presume que las evaluaciones diferirán respecto al atributo crítico. Para este fin, se utilizaron los artículos con nivel de evidencia 2 y 4, esperando una diferencia en la puntuación de la escala de los artículos publicados en los extremos de la puntuación. Resultados: Para realizar la validación de grupos extremos comparamos el desempeño de la nueva escala en relación a los niveles de evidencia 2 y 4; ya que en estos grupos había mayor número de artículos (55 y 48 respectivamente). El promedio de puntuación de la nueva escala de los trabajos con nivel de evidencia 2 fue de 82,21 +/- 13,79 en comparación con la puntuación de los trabajos con nivel de evidencia 4 que fue de 64,97 +/- 17,10 (p = 0,000). Conclusión: Se realizó la validez de constructor de la escala MinCir Pr utilizando la técnica de grupos extremos conocidos.

Hidatidosis de la mama: reporte de un caso / Breast hydatidosis: report of one case

We report a 27 years old female consulting for a left breast nodule. Mammography and breast ultrasound showed a nodule with anechoic content. A fine needle aspiration obtained a crystalline fluid. The nodule was excised and the pathological diagnosis of the surgical piece showed a hydatid cyst.

La hidatidosis humana tiene una tasa de incidencia nacional, notificada en el año 2004, de 2,1 x 100.000 habitantes. Su ubicación en la mama es poco frecuente. Se presenta el caso de una mujer de 27 años con un quiste hidatídico mamario diagnosticado en la Unidad de Anatomía Patológica del Hospital Hernán Henríquez Aravena de Temuco.

[Annual rhythm of menarche in Medellín, Colombia]. / Ritmo anual de la menarquia en Medellín, Colombia.

Hypotheses on seasonal, phylogenetic and ontogenetic factors or imprinting that may produce menarcheal rhythm were tested in a sample of school girls from Medellín, Colombia. The questionnaire included a net of important religious or national feasts and periods of vacation or study to prevent memory biases. European, Asian and Chilean samples showed peaks of menarche in December and January, but a few samples showed a second one in June, July and August. The winter short photoperiod and low temperature were assumed to be the cause of the winter peak in most European samples. However, this seasonal hypothesis was refuted when a Chilean sample also showed a peak in December, January and February (Summer). In the present study performed in a sample from a tropical country we found two peaks of menarche, one in July and the other in November, December and January; thus, the seasonal bypothesis can be hardly supported. Moreover, this sample showed a high coincidence between the month of menarche and the month of birth, and a different pattern of menarche when menarches are distributed according to their coincidence with the gestational development. Both facts affirm the ontogenetic hypothesis, because they were also found in several samples. Since this population is different from those already studied and its monthly distribution of menarches and births is also different from those other ones, the hypothetical phylogenetic factors find additional support. The possible influence of school stress and other environmental factors in the menarcheal rhythm are discussed.

[Annual school and menarche rhythms (vacation-study)]. / Ritmos anuales escolar (vacaciones-estudio) y de menarquia.

BACKGROUND: It has been hypothesized that the yearly menarche rhythm could be caused by the seasonal variation of photoperiod and temperature or by the annual distribution of the scholar vacation and study periods. AIM: To test the hypothesis that the distribution of study vacation periods is a condition that modifies the annual menarche rhythm. SUBJECTS AND METHODS: Two thousand ninety four school girls from Chile, 2,356 girls from Madras, India, 3,454 girls from Medellin, Colombia and 2,627 girls from Debrecen, Hungary, were studied. They were asked about the month of their menarche. Vacation months were considered those with more than 6 days of leave from school. RESULTS: The seasonal hypothesis was refuted because there were contradictions with the expected antithetical behavior in both hemispheres, there was a significant heterogeneity of the yearly menarche among girls from the same region, the expected cline of the menarche frequency variance from equator to poles was not observed, finding an antithetical cline instead and there was a significant heterogeneity among months of the same season. On the other hand, months with vacation periods coincided significantly with peaks of menarche, while study months had lower proportion of menarche (total binomial probability < 10(-6)). Girls whose month of menarche was the same as their month of birth, did not agree completely with the vacation-study hypothesis as the rest of the sample. CONCLUSIONS: Vacation periods influenced menarche rhythm. However, these periods coincide with most cultural events and this strong association needs further study to be considered causal. It is not possible to assume school stress as the main explanatory variable. Ontogenetic factors such as birth imprinting also can influence the menarche rhythm, as shown in girls whose month of menarche coincided with their month of birth.

Introgression of a quantitative trait locus for yield from Glycine soja into commercial soybean cultivars.

The value of exotic germplasm in broadening the genetic base of most crops has been demonstrated many times. However, the difficulties involved in working with exotic germplasm have limited their utility in plant breeding. Unwanted linkages often thwart the successful incorporation of beneficial exotic genes into commercial lines. Thus, the use of exotics in traditional breeding makes the process of crop improvement a tedious, time-consuming and expensive endeavor. The availability of molecular markers makes it possible to isolate specific genomic regions and transfer them into commercial varieties with minimal linkage drag. We found a yield-enhancing quantitative trait locus (QTL) from Glycine soja (Siebold and Zucc.) by evaluating a population of 265 BC(2) individuals from a cross between HS-1 and PI 407305. The yield QTL was located on linkage group B2(U26) of the soybean [Glycine max (L.) Merrill] genetic linkage map. In a 2-year, multi-location study, individuals carrying the PI 407305 haplotype at the QTL locus demonstrated a 9.4% yield advantage over individuals that did not contain the exotic haplotype. When tested in a more uniform "HS-1-like" background in two locations, we observed an 8% yield advantage for lines that carry the PI 407305 haplotype. We further assessed the QTL effect in various elite soybean genetic backgrounds. The yield effect was consistently observed in only two of six genetic backgrounds. Individuals carrying the PI 407305 haplotype at the QTL locus had a 9% yield advantage in yield trials across locations. Despite the limited adaptability of this yield-QTL across genetic backgrounds, this study demonstrates the potential of exotic germplasm for yield enhancement in soybean.

The risk of myocardial ischemia in patients receiving desflurane versus sufentanil anesthesia for coronary artery bypass graft surgery. The S.P.I. Research Group.

Desflurane, a coronary vasodilator, may induce myocardial ischemia in patients with coronary artery disease. To determine whether desflurane is safe to administer to the at-risk patient population (with known coronary artery disease), we compared the incidence and characteristics of perioperative myocardial ischemia in 200 patients undergoing coronary artery bypass graft (CABG) surgery randomly assigned to receive desflurane (thiopental adjuvant) versus sufentanil anesthesia. Under conditions of hemodynamic control, perioperative ischemia was assessed using continuous echocardiography (precordial: during induction; transesophageal: during surgery) and Holter electrocardiography (ECG); hemodynamics (including pulmonary artery pressure) were measured continuously. Hemodynamic results: During induction, no significant changes in hemodynamics occurred in the sufentanil group, while in the desflurane group, heart rate, systemic and pulmonary arterial pressure increased and stroke volume decreased significantly. During the intraoperative period, the incidence of hemodynamic variations was low in both anesthetic groups; however, the prebypass incidence of tachycardia (greater than 120% of preoperative baseline heart rate) was greater in the desflurane group (4 +/- 7% of total time monitored) than in the sufentanil group (1 +/- 6%) (P = 0.0003). Similarly, the incidence of prebypass hypotension (less than 80% of preoperative baseline systolic arterial blood pressure) was greater in the desflurane group (21 +/- 14%) than in the sufentanil group (15 +/- 16%) (P = 0.01). ECG results: Preoperatively, 15% (28/191) of patients developed ECG ischemia, with no difference between patients who received desflurane, 13% (12/96) or sufentanil, 16% (16/95) (P = 0.6). During anesthetic induction, 9% (9/99) of patients who received desflurane developed ECG ischemia, compared with 0% (0/98) who received sufentanil (P = 0.007). During the prebypass period, 5% (10/197) of patients developed ECG ischemia, with no difference between patients who received desflurane, 7% (7/99) or sufentanil, 3% (3/98) (P = 0.3). Postbypass, 12% (24/194) of patients developed ECG ischemic changes, with no difference between patients who received desflurane, 13% (13/97) or sufentanil, 11% (11/96) (P = 0.9). Echocardiographic results: The incidence of precordial echocardiographic ischemia during anesthetic induction was 13% (5/39) in the desflurane group versus 0% (0/29) in the sufentanil group (P = 0.1). Moderate to severe transesophageal echocardiographic (TEE) ischemic episodes occurred in 12% (21/175) of patients during prebypass, with no significant difference between the desflurane group, 16% (15/91) and the sufentanil group, 7% (6/84) (P = 0.09). TEE ischemic episodes occurred in 27% (49/178) of patients during the postbypass period, with no difference between the desflurane, 29% (27/92) and sufentanil, 25% (22/86) groups (P = 0.7).(ABSTRACT TRUNCATED AT 400 WORDS)

Isoflurane anesthesia and myocardial ischemia: comparative risk versus sufentanil anesthesia in patients undergoing coronary artery bypass graft surgery. The SPI (Study of Perioperative Ischemia) Research Group.

Whether isoflurane has the potential to produce coronary artery steal and associated myocardial ischemia is still controversial. Previous studies addressing this issue in humans did not purposefully control hemodynamics or use continuous measures of myocardial ischemia. The authors used transesophageal echocardiography (TEE) and continuous Holter electrocardiography (ECG) to study the relative risk of myocardial ischemia during isoflurane or sufentanil anesthesia under strict control of hemodynamics in 186 high-risk patients undergoing elective coronary artery bypass graft (CABG) surgery. Overall, hemodynamics were well controlled (increased heart rate = 9.8%; increased systolic blood pressure = 7.1%; decreased systolic blood pressure = 10.8% of total prebypass time compared with preoperative baseline values), with no difference between the two anesthetics. In the 162 patients with interpretable TEE recordings, moderate to severe TEE ischemic episodes (grade change greater than or equal to 2) developed in 33 (21%) during the prebypass period, with no difference between isoflurane (12 of 56 = 21%) and sufentanil (21 of 106 = 20%) (P = 0.97). The duration and severity of TEE episodes were not significantly different between the two groups. No correlation was observed between TEE ischemic episodes and isoflurane concentrations (range 0.47-1.75%). In the 181 patients with interpretable ECG recordings, ECG evidence of ischemia developed in 34 (19%) during the prebypass period, with no difference between isoflurane (12 of 59 = 20%) and sufentanil (22 of 122 = 18%) (P = 0.87). The duration and severity of electrocardiographic ischemic episodes were also similar in patients receiving either isoflurane or sufentanil. Four of the 62 patients (6%) who received isoflurane had an adverse cardiac outcome versus 15 of 124 patients (12%) who received sufentanil (P = 0.34). The authors' findings demonstrate that, when hemodynamics are controlled, the incidence of myocardial ischemia (TEE or ECG) during isoflurane and sufentanil anesthesia is similar.

Strong Amerind/white sex bias and a possible Sephardic contribution among the founders of a population in northwest Colombia.

Historical and genetic evidences suggest that the recently founded population of Antioquia (Colombia) is potentially useful for the genetic mapping of complex traits. This population was established in the 16th-17th centuries through the admixture of Amerinds, Europeans, and Africans and grew in relative isolation until the late 19th century. To examine the origin of the founders of Antioquia, we typed 11 markers on the nonrecombining portion of the Y chromosome and four markers on mtDNA in a sample of individuals with confirmed Antioquian ancestry. The polymorphisms on the Y chromosome (five biallelic markers and six microsatellites) allow an approximation to the origin of founder men, and those on mtDNA identify the four major founder Native American lineages. These data indicate that approximately 94% of the Y chromosomes are European, 5% are African, and 1% are Amerind. Y-chromosome data are consistent with an origin of founders predominantly in southern Spain but also suggest that a fraction came from northern Iberia and that some possibly had a Sephardic origin. In stark contrast with the Y-chromosome, approximately 90% of the mtDNA gene pool of Antioquia is Amerind, with the frequency of the four Amerind founder lineages being closest to Native Americans currently living in the area. These results indicate a highly asymmetric pattern of mating in early Antioquia, involving mostly immigrant men and local native women. The discordance of our data with blood-group estimates of admixture suggests that the number of founder men was larger than that of women.

Diseño de una escala para la evaluación de calidad metodológica de estudios de pronóstico / Design of a methodological quality scale for prognostic studies

Background: One of the main classification systems to describe the quality of scientific publications is the level of evidence. However, for our research team, the methodological quality is multidimensional. Aim: To design a scale to determine the methodological quality of studies dealing with prognosis. Material and Method: On a first stage, five professionals with experience in research were interviewed about the items that, in their opinion, must be considered to assess the methodological quality of a manuscript. On a second stage, 121 prognostic studies were critically reviewed by four professionals with research experience In addition, the number of publications of each author was determined and the evidence level of each article was described according to the Oxford Centre for Evidence-based Medicine. A subsequent factorial analysis was performed and the fields and items of the scale were generated. Results: Sixty six percent of reviewed articles had a cohort design (prospective or retrospective), 45 percent were located at an evidence level Ib and 39 percent are at an evidence level of 4. After reviewing the articles, a factorial analysis was performed choosing an orthogonal matrix. A scale (MinCir Pr) was generated with a total of 25 items, 6 fields and a Cronbach coefficient alpha of 0.89. Conclusions: A scale to evaluate the methodological quality of prognosis studies (MinCir Pr) was designed, fulfilling rigorous methodological steps and the criterion of multidimensionality for methodological quality.

Introducción: Uno de los principales sistemas para calificar la calidad de las publicaciones científicas ha sido los niveles de evidencia. Para nuestro equipo de investigación el constructo calidad metodológica es un constructo multidimensional. Nuestro objetivo es diseñar una escala para determinar la calidad metodológica de los estudios referentes a pronóstico. Material y Método: Diseño de generación de escalas. En la primera etapa las fuentes de los ítems fueron entrevistas en profundidad a 5 profesionales con experiencia en investigación y la revisión de la literatura de los diferentes artículos acerca de evaluación de calidad metodológica de los estudios de pronóstico. En la segunda etapa se revisaron 121 estudios de pronóstico por 4 profesionales con experiencia en investigación. Además se analizó el número de publicaciones del autor y se calificó el nivel de evidencia de cada artículo según el centro de evidencia de Oxford. Posteriormente se realizó el análisis factorial y la generación de dominios e ítems de la escala. Resultados: Luego de le etapa de generación de ítems, se analizaron 120 artículos referentes a pronóstico. Un 66 por ciento de los artículos tienen diseño de cohorte (prospectiva o retrospectiva); un 45 por ciento son nivel de evidencia Ib y 39 por ciento son nivel de evidencia 4. Luego de la revisión de artículos se efectuó el análisis factorial escogiendo una matriz ortogonal. Se generó una escala (MinCir Pr) con un total de 25 Ítems, 6 dominios y un coeficiente de alfa de Cronbach de 0,89. Conclusiones: Se ha diseñado una escala para la evaluación de calidad metodológica de estudios de pronóstico (MinCir Pr) cumpliendo rigurosos pasos metodológicos y el criterio de multidimensionalidad de la calidad metodológica.

Asociación entre recuento bacteriano en la bilis y desarrollo de morbilidad postoperatoria en pacientes con colangitis aguda / Association between bile bacterial count and postoperative complications aniong patients with acute cholangitis

Background: Bacterial colonization of bile is common in patients with bile duct obstruction, even in the absence of clinical signs of sepsis. Aim: To determine the association between bile bacterial count and postoperative complications in patients with bile duct obstruction. Material and Methods: A bile bacterial count was performed to patients with acute cholangitis caused by biliary stones, operated between 2004 and 2006. Post operative complications and length of hospital stay were recorded in these patients. Results: Fifty four patients aged between 25 and 95 years (34 females) were studied. The most common bacteria found, were Escherichia coli in 32 cultures (50 percent), followed by Klebsiella pneumoniae in 6 cultures (9 percent). In 45 cases the bacterial load was over 10(5) colony forming units (CFU)/ml. Among patients with and without complications, 68 and 69 percent had a bacterial load over 10(5) CFU/ml, respectively (p = NS). A multivariate analysis showed an association between platelet count and prothrombin time with the incidence of complications. Conclusions: In this series of patients with acute cholangitis, no association between bile bacterial count and postoperative complications was observed.

Introducción: La colonización bacteriana de la bilis parece ser frecuente en pacientes con obstrucción de la vía biliar ya sea con o sin signos de sepsis. Objetivos: Determinar asociación entre el recuento bacteriano en la bilis de pacientes con colangitis aguda (CA) y el desarrollo de complicaciones postoperatorias; y, determinar asociación entre variables fisiológicas y desarrollo de complicaciones en el mismo grupo. Material y Método: Reporte preliminar de estudio de cohorte de pacientes con CA litiásica, intervenidos quirúrgicamente en los servicios de cirugía y urgencias del Hospital Regional de Temuco en el período diciembre de 2004 a noviembre de 2006. Se realizó cultivo cuantitativo y se registraron variables clínicas y de laboratorio al ingreso. Se efectuó medición de complicaciones postoperatorias, estancia hospitalaria y evolución de los pacientes. Se aplicó estadística descriptiva y posteriormente análisis univariado y multivariado. Resultados: Se estudió un total de 54 pacientes, 34 (63 por ciento) fueron de género femenino y 20 (37 por ciento) de género masculino, con una mediana de edad de 68 años (25 a 95 años). El germen más frecuentemente aislado fue Escherichia coli en 32 cultivos (50 por ciento), seguido por Klebsiella pneumoniae en 6 cultivos (9 por ciento). De los gérmenes aislados 45 (82 por ciento) tenían cargas bacterianas sobre 10(5) UFC/ml. De los pacientes que presentaron alguna complicación 68 por ciento tenían cargas bacterianas superiores a 10(5) UFC/ml y de los pacientes que no presentaron complicaciones 69 por ciento tenían cargas bacterianas inferiores a 10(5) UFC/ml (p = 0,513). En el análisis univariado se encontró asociación entre desarrollo de complicaciones y las variables frecuencia cardíaca, creatinina, recuento de plaquetas y tiempo de protrombina. Con el análisis multivariado se determinó asociación entre desarrollo de complicaciones y las variables recuento de plaquetas y tiempo de protrombina (OR: 4,35 y 4,58)...

Revista Chilena de Cirugía: índice de publicación según procedencia de los artículos / Summ affiliation of authors publishing in Revista Chilena de Cirugia

Introducción: Una de las variables que se analiza en los estudios bibliométricos es la procedencia de las publicaciones. Este tipo de análisis ha permitido cuantificar el impacto que tienen las distintas universidades o centros hospitalarios en el total de publicaciones de una revista en particular. El objetivo de este estudio es determinar una eventual asociación entre el índice de publicación y la procedencia de los artículos publicados en la Revista Chilena de Cirugía (Rev Chil Cir). Material y método: Estudio biblio-métrico. Se analizaron todos los artículos publicados en la Rev Chil Cir entre los años 2002 y 2006. Los artículos se categorizaron de acuerdo al año de publicación, el tipo de artículo, región del país que originó el artículo y la filiación universitaria manifestada en cada artículo. Se calculó la tasa de publicación, el promedio anual y general de publicación, y la tasa de publicación anual promedio (TPAP). Posteriormente, se aplicó estadística analítica para determinar diferencias entre grupos, utilizando T de Student, ANOVA y prueba de comparaciones múltiples de Duncan. Resultados: En el periodo estudiado, se publicaron 545 artículos científicos, con un promedio de 18,2 artículos por número y 109 artículos por volumen. El 67,9 por ciento fue generado por la Región Metropolitana (RM), el 10,8 por ciento por la VIII región y el 7,8 por ciento por la IX región. Solo en un 64,8 por ciento de las publicaciones queda de manifiesto alguna filiación universitaria. Las mayores TPAP correspondieron a los Capítulos IX y VIII Región con 2,3 + 0,8 y 1,8 + 0,2 publicaciones/año x 10 miembros (p < 0,05). Conclusiones: Un alto porcentaje de las publicaciones provienen de centros sin filiación universitaria. La mayor TPAP se verificó en regiones.

Background: The analysis of author affiliation of published manuscripts allows an assessment of the impact that different universities or hospitals have on a determinate journal. Aim: To analyze author affiliation of manuscripts published in Revista Chilena de Cirugía. Material and methods: All manuscripts published in the journal between 2002 and 2006, were analyzed. The affiliation of authors, the year of publication and the region of Chile in which the manuscript was generated, were recorded. The publication rate, annual average were calculated. The association of authors to specific regional subsidiaries of the Chilean Society of Surgeons was also recorded and the average annual publication rates per regional subsidiary, were calculated. Resu/fs; During the study period 545 manuscripts were published, with a mean of 18 manuscripts per issue and 109 per volume. Sixty eight percent of manuscripts came from the metropolitan region, 11 percent from the eight region and 8 percent from the ninth region. In only 65 percent of manuscripts, authors had an university affiliation. The higher average annual publication rates were observed in the subsidiaries of the eighth and ninth region, with 2.3 + 0.8 and 1.8 + 0.2 publications per year per 10 members, respectively. Conclusions: An important proportion of manuscripts have authors without university affiliation. The higher average annual publication rates come from regional subsidiaries of the Chilean Society of Surgeons.

Uso de Albendazol como tratamiento de la equinococcosis: toma de decisiones basadas en la validez interna y externa de un estudio concerniente / Internal and external validity of a clinical trial reporting the use of albendazole for the treatment of hydatidosis

Introducción: El tratamiento de la Equinoccocosis es quirúrgico. El estudio de Keshmiri plantea el uso de albendazol como alternativa. El objetivo de este estudio es determinar validez interna y externa del estudio de Keshmiri. Material y método: Se aplicaron 4 instrumentos que valoran diferentes ámbitos metodológicos al estudio de Keshmiri. Se realizó lectura crítica; se analizó calidad metodológica, validez interna y externa con 3 instrumentos: MINCIR, CONSORT y SIGN. Estos, fueron aplicados por 7 investigadores con formación en epidemiología clínica. Resultados: La guía de lectura permitió verificar carencia de objetivo específico, asignación aleatoria y enmascaramiento mal definido. Los pacientes no fueron considerados hasta el final del estudio (hubo pérdida de 22,7 por ciento de pacientes en la rama del fármaco y de 42,8 por ciento de pacientes en la rama placebo). La escala MINCIR permitió identificar un ensayo clínico, con enmascaramiento, secuencia de aleatorización no clara, sin cálculo del tamaño de la muestra y objetivos vagos. CONSORT permitió comprobar carencia de hipótesis de trabajo y objetivos específicos; no identificación de variable primaria y tamaño de muestra, ambigüedades del proceso de aleatorización, enmascaramiento poco claro, ausencia de ajuste estadístico y omisión de análisis de subgrupos. SIGN permitió objetivar los mismos problemas antes descritos. Conclusión: Los instrumentos aplicados, pusieron en evidencia falencias metodológicas que objetan la validez interna y externa del estudio. La adopción de este protocolo debe observarse con precaución.

Background: Classic treatment of echinococcosis is surgery. The study of Keshmiri raises the use of albendazole as an alternative. Aim: To determine internal and external validity of the Keshmiri study. Material and methods: Four instruments that assess methodological quality, were applied to the manuscript. A critical reading was done and the internal and external validity of the methodological quality was analyzed with three scales: Methodology and Research in Surgery (MINCIR), Consolidated Standards of Reporting Trials (CONSORT) and Scottish Intercollegiate Guidelines Network (SIGN). Guides and scales were applied by 7 researchers with training in clinical epidemiology. Results: The Keshmiri study has not a specific objective. The method used for random assignment is not described and not all patients were assessed at the end of the study due to a loss form follow up of 23 percent of patients in drug branch and 43 percent in the placebo branch. MINCIR scale identified a blinded randomized clinical trial, with an unclear randomized sequence, without sample size estimation and vague objectives. CONSORT proved the lack of working hypothesis and specific objectives as well as an absence of identification of the primary variable, absence of sample size calculation, ambiguities in the randomization process, absence of statistical adjustment and the omission of a subgroup analysis. SIGN verified the same methodological errors. Conclusions: The applied instruments found methodological deficiencies that jeopardize the internal and external validity of the study.

Recuento bacteriano en bilis de pacientes con colangitis aguda: Reporte preliminar / Assessment of bacterial load in bile among patients with acute cholangitis

Introducción: No se encuentra bien establecido el rol que desempeña la carga bacteriana de la bilis en la fisiopatología o evolución de los pacientes con colangitis. El objetivo del presente trabajo fue describir la carga bacteriana y los gérmenes más frecuentes en la bilis coledociana de pacientes con colangitis aguda litiásica intervenidos quirúrgicamente en el Hospital Hernán Henríquez de Temuco entre diciembre del año 2004 y marzo del 2005. Material y Método: Estudio de serie de casos prospectiva. Se incluyeron pacientes mayores de 18 años con colangitis aguda litiásica. Los cultivos de la bilis coledociana se sembraron en agar sangre y agar Mac Conkey. Resultados: Se estudió un total de 30 cultivos de bilis. Los gérmenes aislados presentaron cargas bacterianas sobre 105 UFC/ml en 25 cultivos (83,3%), 4 (12,3%) presentaron carga bacteriana inferior a 105 UFC/ml y en 1 cultivo (3,4%) no se registró presencia de gérmenes. El germen más frecuentemente aislado fue Escherichia coli (53%), seguido por Klebsiella pneumoniae (20%). Las bacterias gram negativas no mostraron resistencia a los aminoglucósidos ni cefalosporinas de tercera generación. Los gérmenes gram positivos no mostraron resistencia a la ampicilina y vancomicina. Conclusiones: La carga bacteriana en los pacientes con colangitis aguda litiásica es >105 UFC/ml en la mayoría de los casos. El germen más frecuentemente aislado fue Escherichia coli, seguido por Klebsiella pneumoniae. Llama la atención el aislamiento de Morganella morganii y Citrobacter freundii en 1 cultivo.

Background: The role that bile bacterial load plays in the physiopathology or the evolution of patients with cholangitis has not been well established. Aim: To assess the bacterial load and the most common bacteria infecting the bile of patients with acute gallstone cholangitis. Materials and Methods: A prospective series of patients over 18 years of age with acute gallstone cholangitis operated at Temuco Regional Hospital between December, 2004 and March, 2005. The bile cultures from the choledochus were placed in blood and MacConkey agar plates. Results: A total of 30 bile cultures were studied. In 25 cultures (83%) the bacterial load was over 105 colony forming units (CFU)/ml, four cultures (12.3%) had a bacterial load of less than 105 CFU/ml and one culture (3.4%) was negative. The most commonly isolated bacteria was Escherichia coli (53%), followed by Klebsiella pneumoniae (20%). All gram-negative bacteria were susceptible to either aminoglucosides or third-generation cephalosporins. All gram-positive bacteria were susceptible ampicillin or vancomycin. Conclusions: The bacterial load in patients with acute gallstone cholangitis is >105 CFU/ml in most cases. The most frequently isolated germ was Escherichia coli, followed by Klebsiella pneumoniae.