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BACKGROUND: Cardiac tamponade is a medical emergency that occurs when fluid accumulates in the pericardial space, its prompt diagnosis and treatment can prevent a fatal outcome. OBJECTIVES: We describe a case of cardiac tamponade in a medicine Ward and its subsequent resolution. CLINICAL CASE: 56-year-old male patient with dyspnoea and edematous síndrome, managed with partial response depletive therapy. Echocardiographic study reveals a large pericardial effusion with signs of cardiac tamponade. Inmediate management with ultrasound-guided pericardiocentesis and subsequent surgical resolution. DISCUSSION: The knowledge of the clinical-hemdynamic manifestations and their subsequent pathophysiological background are important in the diagnostic suspicion and management considerations. Echocardiography is a critical component for the final diagnosis, since given its sensitivity and specificity it allows to complete the characterization of the pericardial effusion. In addition, it contributes to reducing the morbidity associated with its drainage.

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Introducción: Las urgencias neurológicas constituyen el 10-15% de las urgencias médicas. Los principales motivos de consulta son la enfermedad cerebrovascular, crisis epilépticas y cefalea. El Hospital Dr. Hernán Henríquez A. (HHHA) comenzó con neurólogos en el Servicio de Urgencia Adultos (SUA) en horario hábil, en abril de 2011. En julio de 2013 se iniciaron turnos con neurólogo 24/7, presenciales en el SUA. Objetivo: Describir el perfil clínico de las consultas neurológicas en el SUA de nuestro centro. Método: Muestra noprobabilística, por conveniencia, de las consultas realizadas en el Turno N°1, del SUA-HHHA, entre octubre de 2013 y septiembre de 2014. El análisis estadístico se realizó con el software STATA 12.0. Resultados: Se registraron 1.080 consultas en el período. 51,2% fueron mujeres. Promedio de edad = 58 años (DE = 20,2). El 36,7% de las consultas se realizó en horario inhábil. Los diagnósticos más frecuentes fueron infarto cerebral (30,7%), epilepsia (15%) y cefalea (11,3%). El 34,6% de los pacientes fue dado de alta; 25,8% se hospitalizó en el Servicio de Medicina Interna; 21% fue derivado a otros hospitales; 12% fue derivado a otros especialistas y 5,7% ingresó a la Unidad de Paciente Crítico. 0,83% de los pacientes falleció en el SUA. Conclusiones: Los principales motivos de consulta neurológica en nuestro Servicio de Urgencia fueron enfermedades cerebrovasculares, epilepsia y cefalea. Debido a que más de un tercio de las consultas ocurre en horario inhábil, se justifica el sistema de neurología 24/7 presencial en el Servicio de Urgencia.

Introduction: Neurological emergencies constitute 10-15% of medical emergencies. The main reasons for consultation are cerebrovascular disease, seizures and headaches. Dr. Hernan Henriquez Hospital (HHHA) began with neurologists in the Adult Emergency Service in April 2011. In July 2013 24/7 neurology shifts at emergency room were added. Objective: To describe the clinical profile of neurologic consultations at our emergency center. Method: A convenience sample of consultations on shift No. 1, at the Adult Emergency Service HHHA between October 2013 and September 2014. The statistical analysis was performed using STATA 12.0 software. Results: 1,080 consultations were recorded in theperiod. 51.2% were women. Mean age = 58 years (SD = 20.2). 36.7% of consultations are conducted in a non-business hour. The most frequent diagnoses were stroke (30.7%), epilepsy (15%) and headache (11.3%). 34.6% ofpatients were discharged; 25.8% were hospitalized in the Internal Medicine dept; 21% were referred to other hospitals; 12% were referred to other specialists and 5.7% were admitted to Critical Patient Unit. 0.83% of the patients died in the SUA. Conclusions: The main reasons for neurological consultation at our Emergency Service were cerebrovascular disease, epilepsy and headaches. Because more than a third of consultations occur on non-schedule hours, neurology system 24/7 shifts are justified in the Emergency Service.

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Chile is considered the third major exporter of kiwifruits (Actinidia deliciosa (A. Chev.) C. F. Liang & A. R. Ferguson) worldwide after Italy and New Zealand (1). The genus Diaporthe Nitschke (anamorph: genus Phomopsis) has been reported as causing postharvest rot in kiwifruit (4). During the current study, 1,400 fruits arbitrarily collected from seven controlled atmosphere (CA) rooms after 90 days of storage conditions (2% O2, 5% CO2) determined that 21.5% of the fruit were affected by decay and 0.86% developed symptoms different than those caused by Botrytis cinerea, the main postharvest pathogen associated to kiwifruit. Symptoms were soft rot with brown skin that started at the stem-end and in severe cases affected the entire fruit. Internally, affected fruit showed browning and watery tissues. Twelve affected fruits were surface disinfested (75% ethanol) and small pieces of internal rotten tissues were placed on acidified potato dextrose agar (APDA) for 7 days at 20°C. Twelve isolates were obtained, and four of them were identified morphologically and molecularly as Diaporthe ambigua, a species that has been previously described causing rot in stored kiwifruits in Chile (2). However, eight other flat, white to grayish colonies with sparse dirty-white aerial mycelium at the edge of the dish were obtained (3). Black pycnidia contained unicellular, hyaline, biguttulate, oval to cylindrical alpha conidia, with obtuse ends of (7.9) 6.7 (5.3) × (2.9) 2.5 (2.1) µm (n = 30). These isolates were tentatively identified as a Diaporthe sp. The species identification was determined by sequencing comparison of the internal transcribed spacer (ITS1-5.8S-ITS2) region of the rDNA (GenBank Accession Nos. KJ210020 to 24, KJ210027, and KJ210033) and a portion of beta-tubulin (BT) (KJ210034 to 38, KJ210041, and KJ210047) using primers ITS4-ITS5 and Bt2a-Bt2b, respectively. BLAST analyses showed 99 to 100% identity with D. novem J.M. Santos, Vrandecic & A.J.L Phillips reference ex-type (KC343156 and KC344124 for ITS and BT, respectively) (3). Eighteen mature kiwifruits cv. Hayward were inoculated using a sterile cork borer on the surface of the fruit and placing 5-mm agar plugs with mycelial of D. novem (DN-1-KF). An equal number of fruits treated with sterile agar plugs were used as negative controls. After 30 days at 0°C under CA, all inoculated fruit showed rot symptoms with lesions 7.8 to 16.4 mm in diameter. The same D. novem isolate was inoculated with 30 µl of a conidial suspension (106 conidia/ml) on the surface of 18 ripe kiwifruits that were previously wounded and non-wounded as described above. An equal number of wounded and non-wounded fruits, treated with 30 µl sterile water, were used as negative controls. All inoculated wounded fruits developed rot symptoms with necrotic lesions of 14.1 to 20.2 mm of diameter after 14 days at 25°C. Inoculated non-wounded and negative control fruits remained symptomless. Koch's postulates were fulfilled by re-isolating D. novem only from the symptomatic fruits. To our knowledge, this is the first report of rot caused by D. novem on kiwifruit during cold storage in Chile and worldwide. Therefore, both Diaporthe species appears to be associated to Diaporthe rot of kiwifruit in Chile. References: (1) Belrose, Inc. World Kiwifruit Review. Belrose, Inc. Publishers, Pullman, WA, 2012. (2) J. Auger et al. Plant Dis. 97:843, 2013. (3) R. Gomes et al. Persoonia 31:1, 2013. (4) L. Luongo et al. J. Plant Pathol. 93:205, 2011.

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BACKGROUND: A significant number of students in health careers do not have the knowledge to approve basic courses. Therefore, educational programs to level off knowledge have been developed. AIM: To associate the results of a leveling program with the academic performance in cell biology (CB) and biochemistry (BC) of first year medical students. MATERIAL AND METHODS: We applied a test to first year medical students at the beginning and end of the leveling program (control test). The results obtained at the end of the leveling program were correlated with the results obtained in CB and BC. RESULTS: Fifty seven of 89 (64%) first year medical students met the study entry criteria (54% female). Students who completed the leveling program had a significantly higher approval rate in CB (93% versus 75%, P = 0.024), and in BC (95% versus 69%, P = 0.001). After completing the leveling program, the risk of failing CB and BC, decreased by 72 and 84% respectively. CONCLUSIONS: This study shows that medical students who participate in the leveling program decrease the chances of failing in CB and BC.

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Introducción: La calidad de vida infantil está asociada con las propias vivencias de los menores, la de sus familias, como con variables del entorno sociocultural donde se desarrollan. Objetivo: Identificar los componentes significativos en la evaluación de la calidad de vida desde la percepción infantil. Participantes y Método: Bajo un diseño transversal, se aplicó la Escala de Calidad de Vida Infantil a un total de 200 niños y niñas de 8 a 12 años de una comuna urbana y de una comuna rural ubicadas al Norte de Chile. Se presentaron tres preguntas abiertas sobre experiencias de satisfacción, insatisfacción y deseos de cambio, clasificando las respuestas en 6 dimensiones. Resultados: Muestran la inexistencia de diferencias en la percepción de calidad de vida en niños urbanos y rurales a partir del cuestionario; sin embargo, la evaluación del contenido de las preguntas abiertas permitió establecer algunas diferencias entre ambos grupos. Conclusión: En la comuna urbana, las mayores experiencias de satisfacción se dieron a nivel de las relaciones interpersonales, en tanto en el sector rural, en torno a las actividades de ocio y recreativas.

Background: The quality of life in children is associated with their experiences, family and their socio-cultural environment. Objective: To identify the significant components in assessing quality of life from the children's perception. Participants and Method: Using a cross-sectional design, the Child Life Quality Scale was applied to a total of 200 children aged 8-12 years, from an urban and a rural area located in northern Chile. Three open questions were presented about experiences of satisfaction, dissatisfaction and desire for change, classifying the answers in six categories. Results: No significant differences in the perception of quality of life in children from urban and rural areas were found, however, the evaluation of the content of the answers allowed us to establish some differences between the two groups. Conclusion: In the urban area, the greatest experiences of satisfaction level were associated with interpersonal relationships, while in the rural area, with leisure and recreational activities.

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Background: A significant number of students in health careers do not have the knowledge to approve basic courses. Therefore, educational programs to level off knowledge have been developed. Aim: To associate the results of a leveling program with the academic performance in cell biology (CB) and biochemistry (BC) of first year medical students. Material and Methods: We applied a test to first year medical students at the beginning and end of the leveling program (control test). The results obtained at the end of the leveling program were correlated with the results obtained in CB and BC. Results: Fifty seven of89 (64%) first year medical students met the study entry criteria (54% female). Students who completed the leveling program had a significantly higher approval rate in CB (93% versus 75%, P = 0.024), and in BC (95% versus 69%, P = 0.001). After completing the leveling program, the risk of failing CB and BC, decreased by 72 and 84% respectively Conclusions: This study shows that medical students who participate in the leveling program decrease the chances of failing in CB and BC.

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Urinary tract infections (UTIs) affect both healthy and immunocompromised people, and they are treated with antibiotics. However, the high recurrence of UTIs obliges the use of natural mechanisms to regulate the normal microbiota through the use of e.g. lactic acid bacteria. In order to induce a UTI, 20 µl of the Escherichia coli (Ec-01) strain, in doses of 2.7×10(7) cfu/ml, was inoculated by way of the urethra in female Balb/c mice, all of them immunosuppressed with dexamethasone (10 mg/kg). Lactobacillus plantarum LPLM-O1 was used as a treatment, in daily doses of 1×10(7) cfu/ml, which were orally administered for seven days before the infection (preventive) or alongside the infection for seven days (curative). The oral administration of LPLM-O1 did not cause any adverse effects when used in an immunosuppressed animal model. It was observed that, when used as a preventive measure, LPLM-O1 induces a decrease in the infection, in the concentration of urinary leukocytes, and in the bacterial load. This study proposes the use of this lactic bacterium as a probiotic.

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The aim of the present study was to develop a classifier able to discriminate between healthy controls and dyspeptic patients by analysis of their electrogastrograms. Fifty-six electrogastrograms were analyzed, corresponding to 42 dyspeptic patients and 14 healthy controls. The original signals were subsampled, filtered and divided into the pre-, post-, and prandial stages. A time-frequency transformation based on wavelets was used to extract the signal characteristics, and a special selection procedure based on correlation was used to reduce their number. The analysis was carried out by evaluating different neural network structures to classify the wavelet coefficients into two groups (healthy subjects and dyspeptic patients). The optimization process of the classifier led to a linear model. A dimension reduction that resulted in only 25 percent of uncorrelated electrogastrogram characteristics gave 24 inputs for the classifier. The prandial stage gave the most significant results. Under these conditions, the classifier achieved 78.6 percent sensitivity, 92.9 percent specificity, and an error of 17.9 ± 6 percent (with a 95 percent confidence level). These data show that it is possible to establish significant differences between patients and normal controls when time-frequency characteristics are extracted from an electrogastrogram, with an adequate component reduction, outperforming the results obtained with classical Fourier analysis. These findings can contribute to increasing our understanding of the pathophysiological mechanisms involved in functional dyspepsia and perhaps to improving the pharmacological treatment of functional dyspeptic patients.

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The aim of the present study was to develop a classifier able to discriminate between healthy controls and dyspeptic patients by analysis of their electrogastrograms. Fifty-six electrogastrograms were analyzed, corresponding to 42 dyspeptic patients and 14 healthy controls. The original signals were subsampled, filtered and divided into the pre-, post-, and prandial stages. A time-frequency transformation based on wavelets was used to extract the signal characteristics, and a special selection procedure based on correlation was used to reduce their number. The analysis was carried out by evaluating different neural network structures to classify the wavelet coefficients into two groups (healthy subjects and dyspeptic patients). The optimization process of the classifier led to a linear model. A dimension reduction that resulted in only 25% of uncorrelated electrogastrogram characteristics gave 24 inputs for the classifier. The prandial stage gave the most significant results. Under these conditions, the classifier achieved 78.6% sensitivity, 92.9% specificity, and an error of 17.9 +/- 6% (with a 95% confidence level). These data show that it is possible to establish significant differences between patients and normal controls when time-frequency characteristics are extracted from an electrogastrogram, with an adequate component reduction, outperforming the results obtained with classical Fourier analysis. These findings can contribute to increasing our understanding of the pathophysiological mechanisms involved in functional dyspepsia and perhaps to improving the pharmacological treatment of functional dyspeptic patients.

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AIMS: To evaluate the distribution of Bacillus thuringiensis strains from maize and bean phylloplane and their respective soils. METHODS AND RESULTS: B. thuringiensis was isolated from the phylloplane and soil of maize and bean from three municipalities in Antioquia, Colombia. Ninety six samples of phylloplane and 24 of soil were analyzed. A total of 214 isolates were obtained from 96 phylloplane samples while 59 isolates were recovered from 24 soil samples. Sixty five per cent and 12% of the phylloplane and soil isolates, respectively, showed activity against Spodoptera frugiperda. These isolates contained delta-endotoxin proteins of 57 and 130 kDa. The most toxic isolates against S. frugiperda had the genotype cry1Aa, cry1Ac, cry1B, and cry1D. In contrast, 27% of the phylloplane isolates and 88% of the soil isolates were active against Culex quinquefasciatus and had protein profiles similar to B. thuringiensis serovar. medellin and B. thuringiensis serovar. israelensis. The most active isolates contain cry4 and cry11 genes. CONCLUSIONS: The predominant population of B. thuringiensis on the phylloplane harbored the cry1 gene and was active against S. frugiperda, whereas in soil, isolates harboring cry11 gene and active against C. quinquefasciatus were the majority. SIGNIFICANCE AND IMPACT OF THE STUDY: The predominance of specific B. thuringiensis populations, both on the leaves and in the soil, suggests the presence of selection in B. thuringiensis populations on the studied environment.

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Background: Nonsyndromic cleft lip/palate (NSCLP) is a congenital malformation with the characteristics of a complex genetic trait. Based on experimental evidences as well as on association and linkage studies candidate genes TGFA, RARA and BCL3 have been postulated as being involved in the genetic etiology of this pathology. Aim: To test the possible association due to linkage disequilibrium between microsatellite markers located at less than 1cM from the three candidate genes and nonsyndromic cleft lip/palate using the case-parents trio design. Patients and Methods: The sample consisted of 58 case-parents trios. Two microsatellite markers, flanking each one of the candidate genes were analyzed by means of the polymerase chain reaction (PCR) with fluorescent labeled microsatellite markers. Electrophoresis of the PCR products was performed on a laser-fluorescent automatic DNA sequencer. Nonparametric ETDT was used to analyze the genotype data. Results: Significant linkage disequilibrium was detected between D2S443 (TGFA) and NSCLP. Significance was almost reached between D17S800 (RARA) and NSCLP. Alleles 239bp (D2S443) and 172bp (D17S800) showed significant preferential transmission from heterozygous parents to affected offspring. In the case of BCL3 both markers showed no significant results. Conclusions: The results of the present study do not show clear evidence that TGFA or RARA could be involved in the genetic etiology of NSCLP. Even though the importance of retinoic acid in the development of the embryo is well documented the results obtained for RARA are difficult to analyze. In relation to the possible role of BCL3 in NSCLP, recent information postulates that other genes located in the same chromosome region could be involved in NSCLP.

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Se presenta la experiencia de los autores en 19 casos en que se realizó biopsia placentaria para determinar el cariotipo fetal en el segundo trimestre del embarazo

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BACKGROUND: The beneficial effects of estrogen supplementation in climacteric women are clear. However, their psychological effects are not well documented. AIM: To study the effects of estrogen supplementation on psychological variables in climacteric women. SUBJECTS AND METHODS: Forty postmenopausal women were divided in two groups to receive a daily dose of 2 mg oestradiol valerate and 2.5 mg medroxyprogesterone acetate or an identical placebo during six months. Initially and at the end of the treatment period, they were subjected to a psychiatric interview and the Graffar, Hamilton and Eysenk personality tests were applied. Also, an Analysis of Verbal Behavior was used, that results in hope and hopeless scores. RESULTS: There were no differences in the initial assessment between the two treatment groups. In women receiving hormonal supplementation, the Hamilton score decreased from 11.2 to 4.9 (p < 0.002) and in women receiving placebo from 8.1 to 5.3 (NS). No other significant changes in psychological tests were observed. CONCLUSIONS: Hormonal supplementation decreases the Hamilton depression score in postmenopausal women.

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Se comunica el manejo y resultado perinatal de 29 casos de embarazo múltiple (23 triples, 5 cuádruples y 1 séxtuple), ocurridos en un período de 10 años. La edad gestacional promedio al parto fue de 33 y 30 semanas para triples y cuádruples, con un peso promedio de nacimiento de 1.773 g para triples y de 1208 g para cuádruples. Las principales patologías obstétricas fueron la amenaza de parto prematuro (37 por ciento), el RCIU, la RPM y el edema gravídico (25 por ciento cada uno), y la preclampsia y la anemia (17 por ciento c/u). El parto resolvió por cesárea en el 96 por ciento de los casos (23/24). Entre los recién nacidos vivos (60 triples y 16 cuádruples) hubo una muerte a los 108 días de vida. El seguimiento realizado en 69/75 RN dados de alta, revela normalidad en el 90 por ciento de ellos. El diagnóstico precoz, el control prenatal con pesquisa y tratamiento de patologías obstétricas, la ecografía de excelencia, el parto programado por cesárea y el manejo intensivo del recién nacido, son los principales determinantes del buen pronóstico observado en estos casos de embarazo múltiple

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El acceso a la circulación umbilical del feto guiado por ecografía ofrece una alternativa al manejo habitual de la enfermedad hemolítica fetal. La técnica implica tomar una muestra de sangre fetal, medición del hematocrito y una transfusión intravascular. Presentamos el caso de un embarazo Rh(-) altamente sensibilizado, que fue tratado con cinco transfusiones intrauterinas a través del cordón umbilical bajo visión ecográfica directa. Se discuten los aspectos técnicos y complicaciones del procedimiento

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Se presenta una familia formada por 15 miembros, de los cuales 10 son consanguíneos portadores de una asociación de defecto radial, labio leporino complicado y ectrodactilia, lo que se hereda en forma autosómica dominante con penetrancia incompleta y expresividad variable. Se postula una alteración génica a nivel de genes que actúan durante el período embrionario

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