RESUMO
Abstract To evaluate stress distribution when applying vertical and tangential forces to 1mm thick occlusal veneers with different finish lines preparations, using the finite element method. One extracted third molar was prepared for occlusal veneers, firstly without any bevel. It was scanned in order to design two groups of lithium disilicate (G1A, G2A) and composite resin (G1B, G2B) occlusal veneers. Then, the third molar preparation was modified, beveling the finish line and it was subsequently scanned again to design the occlusal veneer groups with bevel (LD: G3A, G4A and CR: G3B, G4B). The four groups were subjected to different forces (400 N vertical and 900 N tangential). At 400 N, the non-beveled veneers showed slightly higher Von Mises stress values (G1A: 783 MPa and G1B 736.5 MPa) than the beveled veneers (G3A: 685.7 MPa and G3B: 675.8 MPa). However, when 900 N tangential forces were applied, the beveled occlusal veneers showed higher Von Mises stress values (G4A: 4297 MPa and G4B: 4133 MPa) than the non-beveled occlusal veneers (G2A: 2581.1 MPa and G2B: 3519.1 MPa). Furthermore, it was observed that the tissue under the occlusal veneers with bevel showed higher Von Mises stress values than the models without any bevel. Beveled and non-beveled occlusal veneers of lithium disilicate and composite resin presented similar stress distribution values when vertical forces of 400 N were applied; whereas with tangential forces of 900 N applied near to the finish line, the beveled groups presented notably higher stress values than the non-beveled groups. However, both finish line preparations presented adequate values for possible clinical performance.
Resumen Evaluar la distribución de estrés al aplicar fuerzas verticales y tangenciales en carillas oclusales de 1mm de espesor con diferentes líneas de terminación marginal por el método de elementos finitos. Se preparó un tercer molar extraído para carilla oclusal, primero sin bisel. Se escaneó para diseñar dos grupos de carillas oclusales de disilicato de litio (G1A, G2A) y resina compuesta (G1B, G2B). Después, esta preparación molar fue modificada, biselando la línea de terminación y escaneándola nuevamente para diseñar los grupos de carillas oclusales con bisel (DL: G3A, G4A and RC: G3B, G4B). Los 4 grupos fueron sometidos a fuerzas diferentes (400 N vertical y 900 N tangencial). Con 400 N, las carillas sin bisel presentaron ligera mayor tensión de Von Mises (G1A: 783 MPa y G1B 736.5 MPa) que las carillas con bisel (G3A: 685.7 MPa y G3B: 675.8 MPa). De distinta forma, al aplicar fuerzas tangenciales de 900 N, las carillas oclusales con bisel presentaron mayor tensión de Von Mises (G4A: 4297 MPa y G4B: 4133 MPa) que las carillas oclusales sin bisel (G2A: 2581.1 MPa y G2B: 3519.1 MPa). Además, se observó que los tejidos subyacentes a las carillas oclusales con bisel, presentaron mayor tensión de Von Mises, frente a los modelos sin bisel. Las carillas oclusales con y sin bisel de disilicato de litio y resina compuesta presentaron una distribución de estrés similar con fuerzas verticales de 400 N, por otro lado, con fuerzas tangenciales de 900 N, los grupos con bisel presentaron notablemente mayor tensión que los grupos sin bisel. Sin embargo, ambos diseños de terminación marginal presentaron valores adecuados para un posible desempeño clínico.
Assuntos
Humanos , Força de Mordida , Resinas Compostas , Facetas DentáriasRESUMO
BACKGROUND: The COVID-19 pandemic posed a great strain in health services. AIM: To describe the epidemiological and clinical features of patients with SARS-CoV-2 admitted to a regional hospital in southern Chile between April and August 2020. MATERIAL AND METHODS: Clinical records of all hospitalized patients with RT-PCR (+) for SARS-CoV-2 were retrospectively analyzed. RESULTS: During the study period 226 patients aged 55 ± 18 years (55% men) were admitted. The main comorbidities were high blood pressure in 45%, diabetes in 31% and obesity in 21%. The main symptoms were dyspnea in 70%, cough in 69%, fever in 62% and myalgia in 47%. Pneumonia was the main cause of admission in 66%. Images on admission were compatible with pneumonia in 81%, and with a typical COVID-19 pattern in 84%. In 76% there was five-lobe involvement. Eighty-seven cases (39%) were admitted to critical care, with an APACHE score of 10.9 ± 7.1. Invasive mechanical ventilation was used in 16%, 30% required prone position and 13%, a high-flow nasal cannula. The mean stay in critical care was 13.3 days. The mean duration of invasive mechanical ventilation was 14.1 days. Antimicrobials were used in 55% and dexamethasone in 36%. Twenty-two (9.7%) patients aged 71.7 ± 14 died. A Charlson comorbidity index > 3, heart failure and connection to invasive mechanical ventilation were independent risk factors for death. An age > 65 years alone and other comorbidities were not risk factors. CONCLUSIONS: Viral pneumonia is the main cause of hospitalization for COVID-19, usually extensive and bilateral. The greater severity and poor prognosis of these patients are mainly related to comorbidities.
Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Chile/epidemiologia , Dexametasona , Feminino , Hospitalização , Hospitais , Humanos , Masculino , Respiração Artificial , Estudos Retrospectivos , SARS-CoV-2RESUMO
BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. MATERIAL AND METHODS: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. CONCLUSIONS: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.
Assuntos
COVID-19 , Influenza Humana , Pneumonia Viral , Adulto , COVID-19/epidemiologia , Dispneia , Hospitalização , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , SARS-CoV-2RESUMO
BACKGROUND: The COVID-19 pandemic posed a great strain in health services. AIM: To describe the epidemiological and clinical features of patients with SARS-CoV-2 admitted to a regional hospital in southern Chile between April and August 2020. MATERIAL AND METHODS: Clinical records of all hospitalized patients with RT-PCR (+) for SARS-CoV-2 were retrospectively analyzed. RESULTS: During the study period 226 patients aged 55 ± 18 years (55% men) were admitted. The main comorbidities were high blood pressure in 45%, diabetes in 31% and obesity in 21%. The main symptoms were dyspnea in 70%, cough in 69%, fever in 62% and myalgia in 47%. Pneumonia was the main cause of admission in 66%. Images on admission were compatible with pneumonia in 81%, and with a typical COVID-19 pattern in 84%. In 76% there was five-lobe involvement. Eighty-seven cases (39%) were admitted to critical care, with an APACHE score of 10.9 ± 7.1. Invasive mechanical ventilation was used in 16%, 30% required prone position and 13%, a high-flow nasal cannula. The mean stay in critical care was 13.3 days. The mean duration of invasive mechanical ventilation was 14.1 days. Antimicrobials were used in 55% and dexamethasone in 36%. Twenty-two (9.7%) patients aged 71.7 ± 14 died. A Charlson comorbidity index > 3, heart failure and connection to invasive mechanical ventilation were independent risk factors for death. An age > 65 years alone and other comorbidities were not risk factors. CONCLUSIONS: Viral pneumonia is the main cause of hospitalization for COVID-19, usually extensive and bilateral. The greater severity and poor prognosis of these patients are mainly related to comorbidities.
Assuntos
Humanos , Masculino , Feminino , Pandemias , COVID-19/epidemiologia , Respiração Artificial , Dexametasona , Chile/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Hospitalização , HospitaisRESUMO
BACKGROUND: In a decade, we faced two pandemic viruses, influenza A H1N1pdm09 and SARS CoV-2, whose most serious manifestation is pneumonia. AIM: To compare the clinical, epidemiological and management aspects of pneumonias caused by each pandemic virus in adults requiring hospitalization. Material and Methods: Comparative, observational study carried out at a regional Chilean hospital, including 75 patients with influenza A H1N1pdm09 prospectively studied in 2009 and 142 patients with SARS-CoV-2 studied in 2020. RESULTS: Patients with SARS-CoV-2 pneumonia were older (56 and 39.7 years respectively, p < 0.01) and had significantly more comorbidities. Cough, fever and myalgias were more frequent in influenza. Dyspnea was more frequent in COVID-19. Patients with COVID-19 had more extensive lung involvement and a longer hospitalization (13.6 and 8.6 days respectively, p = 0.01). There was no difference on ICU admission requirements and mortality attributable to pneumonia. Patients with influenza had greater APACHE scores and a higher frequency of a PaO2/FiO2 ratio ≤ 200. During COVID-19pandemic chest sean replaced x-ray examination. Also high-flow nasal cannulas and awake prone position ventilation were added as treatments. Conclusions: COVID-19 patients were older, had fewer classic flu symptoms but more dyspnea and longer hospitalization periods than patients with influenza.
Assuntos
Humanos , Adulto , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Pneumonia Viral/epidemiologia , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , COVID-19/epidemiologia , Dispneia , Pandemias , SARS-CoV-2 , HospitalizaçãoRESUMO
Acremonium strictum Elicitor Subtilisin (AsES) is a fungal elicitor that activates innate immunity, conferring disease resistance in strawberry (Fragaria × ananassa Duch.), Arabidopsis and other plant species. The aim of the present work was to evaluate the involvement of the ethylene (ET) signalling pathway in AsES-mediated immune response in strawberry. Ethylene production and expression of the genes responsible for ET synthesis, perception and response were measured after AsES treatment. ROS (H2 O2 ) accumulation and immunity induced by AsES were studied after ET perception was blocked by 1-methylcyclopropene (1-MCP). Biochemical and molecular results showed that AsES induced a marked increase in local and systemic biosynthesis of ET, both in a biphasic manner. Blocking of ET perception by 1-MCP prior to AsES induction reduced production of ROS (H2 O2 ) and prevented AsES from eliciting defence against fungal pathogens having different lifestyles, such as Botrytis cinerea (necrotrophic) and Colletotrichum acutatum (hemibiotrophic). These findings contribute to elucidate the mode of action of the novel elicitor subtilase, AsES, specifically regarding the role of ET signalling in the activation of plant innate immunity, in addition to the multitude of processes regulated by ET in plants.
Assuntos
Etilenos , Fragaria , Transdução de Sinais , Subtilisina , Etilenos/metabolismo , Fragaria/efeitos dos fármacos , Fragaria/imunologia , Fragaria/metabolismo , Regulação da Expressão Gênica de Plantas/efeitos dos fármacos , Hypocreales/química , Transdução de Sinais/efeitos dos fármacos , Subtilisina/farmacologiaRESUMO
Los objetivos principales del tratamiento de endodoncia no quirúrgico son la prevención y/o tratamiento de periodontitis apical junto con la resolución de signos y síntomas de las lesiones pulpares irreversibles. Debido a la compleja morfología del sistema de conductos radicular, la persistencia de un conducto no tratado puede mantener la contaminación y sintomatología pulpar y periapical. La prevalencia para MV2 reportado a nivel mundial para el primer molar superior varía ampliamente según las técnicas in vivo o ex vivo empleadas en cada estudio, es por esto que el presente trabajo tiene por objetivo evaluar la prevalencia de MV2 en primeros molares superiores en base a cuatro técnicas diagnósticas aplicadas ex vivo. Se realizó un estudio transversal observacional en 101 primeros molares superiores extraídos bajo consentimiento informado para determinar la prevalencia del conducto MV2 y su morfología en base a las técnicas de radiografía ortoradial, tomografía Cone Beam, apertura coronaria con microscopio quirúrgico (16x) y cortes radiculares axiales de aplicación ex vivo. La prevalencia encontrada para MV2 por cada técnica fue de 81,1 % para cortes radiculares y tomografía Cone Beam, 59,4 % para la apertura coronal con microscopio (16x) y 32,6 % con radiografía ortoradial. En el 3,96 % de la muestra se encontró un tercer conducto mesiovestibular en base a la técnica de corte radicular. La morfología interna del sistema de conductos radiculares fue de 36 % clase II, 19 % clase I y 16 % clase IV de Vertucci. Los resultados del presente estudio están en concordancia con lo reportado en la literatura y confirman la mayor prevalencia reportada en estudios ex vivo para esta situación. La presencia de MV2 en el primer molar superior es una condición frecuente que el endodoncista debe considerar, empleando técnicas imagenológicas y tecnologías de magnificación para asegurar el éxito terapéutico en estos dientes.
The main objectives of non-surgical endodontic treatment are the prevention and / or treatment of apical periodontitis, as well as resolving signs and symptoms of irreversible pulpal lesions. Considering the complex morphology of the root canal system, the a canal left untreated, can generate contamination, pulp and periapical symptoms. The prevalence for MV2 reported worldwide for the upper first molar, varies depending on the ex vivo or ex vivo techniques used in each study. Consequently, the present work aims to assess the prevalence of MV2 in first upper molars based on four ex vivo diagnostic techniques applied. An observational crosssectional study was performed in 101 upper first molars extracted under informed consent to determine the prevalence of the MV2 duct and its morphology based on orthoradial radiography, Cone Beam tomography, coronary opening with a surgical microscope (16x), and axial root cuts applied ex vivo. The prevalence found for MV2 by each technique was 81.1 % for root cuts and Cone Beam tomography, 59.4 % for coronal opening with a microscope (16x) and 32.6 % with orthoradial radiography. In 3.96 % of the sample, a third mesiovestibular canal was found based on the root cutting technique. The internal morphology of the root canal system was 36 % Vertucci´s class II, 19 % class I and 16 % class IV. The results of the present study coincide with that reported in the literature, and confirm the higher prevalence reported in ex vivo studies for this situation. The presence of MV2 in the upper first molar is a frequent condition that the endodontist must consider, using imaging techniques and magnification technology to ensure therapeutic success in these teeth.
Assuntos
Humanos , Cavidade Pulpar/anatomia & histologia , Dente Molar/anatomia & histologia , Chile , Prevalência , Estudos TransversaisRESUMO
BACKGROUND: Women in Chile are mainly responsible in the formation of eating habits in the population, particularly at their homes. AIM: To explore the association of physical activity and alimentary habits with overweight among adult Chilean women in fertile age. MATERIAL AND METHODS: Cross sectional study using the data from de National Health Survey 2009-2010. Socio-demographic variables, dietary issues, multidimensional physical activity, sedentary free time and their link with nutritional status were studied in a sample of 1,195 women aged between 20 and 44 years. RESULTS: Sixty three percent of women were overweight. The factors positively associated overweight were having an age between 31 and 44 years (prevalence ratio (PR) = 1.4), having a lower education level (PR = 1.23), living in rural areas (PR = 2.21) and being exposed to work environment (PR = 1.29). The factors negatively associated with overweight were the consumption of whole grains at least once daily (PR = 0.59), being physically active according to a self-assessment scale (PR = 0.22) and being physically inactive during leisure time (PR = 0.61). CONCLUSIONS: The promotion whole grain cereal consumption and physical activity in women is advisable to prevent overweight, mostly in vulnerable groups such as those older than 31 years, with a low educational level and living rural areas.
Assuntos
Exercício Físico , Comportamento Alimentar , Sobrepeso/epidemiologia , Adulto , Fatores Etários , Chile/epidemiologia , Estudos Transversais , Exercício Físico/fisiologia , Comportamento Alimentar/fisiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Estado Nutricional , Sobrepeso/etiologia , Sobrepeso/fisiopatologia , Fatores de Risco , Comportamento Sedentário , Fatores SocioeconômicosRESUMO
Background: Women in Chile are mainly responsible in the formation of eating habits in the population, particularly at their homes. Aim: To explore the association of physical activity and alimentary habits with overweight among adult Chilean women in fertile age. Material and Methods: Cross sectional study using the data from de National Health Survey 2009-2010. Socio-demographic variables, dietary issues, multidimensional physical activity, sedentary free time and their link with nutritional status were studied in a sample of 1,195 women aged between 20 and 44 years. Results: Sixty three percent of women were overweight. The factors positively associated overweight were having an age between 31 and 44 years (prevalence ratio (PR) = 1.4), having a lower education level (PR = 1.23), living in rural areas (PR = 2.21) and being exposed to work environment (PR = 1.29). The factors negatively associated with overweight were the consumption of whole grains at least once daily (PR = 0.59), being physically active according to a self-assessment scale (PR = 0.22) and being physically inactive during leisure time (PR = 0.61). Conclusions: The promotion whole grain cereal consumption and physical activity in women is advisable to prevent overweight, mostly in vulnerable groups such as those older than 31 years, with a low educational level and living rural areas.
Assuntos
Humanos , Feminino , Adulto , Exercício Físico/fisiologia , Sobrepeso/epidemiologia , Comportamento Alimentar/fisiologia , Fatores Socioeconômicos , Chile/epidemiologia , Estado Nutricional , Estudos Transversais , Fatores de Risco , Inquéritos Epidemiológicos , Fatores Etários , Sobrepeso/etiologia , Sobrepeso/fisiopatologia , Comportamento SedentárioRESUMO
PURPOSE: We compared biochemical control and quality of life with intermittent (6 months) versus continuous (36 months) androgen deprivation therapy (ADT) in a non-inferiority randomized phase 3 trial in patients with biochemical failure (BF) after external beam radical radiotherapy (EBRT). MATERIALS AND METHODS: Patients were stratified according to the Gleason score (GS) and were classified as low risk with a GS < 6 and 7 (3 + 4) and high risk with a GS of 7 (4 + 3) and >7. Patients were followed with PSA determinations and quality-of-life assessments (QLQ C-30 and QLQ PR-25) every 6 months for a period of 3 years. BF after radiation was defined as a PSA level of nadir +2 ng/ml. Disease progression (DP) after ADT was defined as PSA ≥4 ng/ml (BF) and/or metastases. RESULTS: Seventy-seven patients were included in this multicenter phase 3 trial from 2005 to 2009. Thirty-eight and 39 patients were included in the intermittent and continuous groups, respectively. The median follow-up for both groups was 48 months (40-68). DP after ADT in the intermittent group was seen in three patients (distant metastases in one patient) versus 0 in the continuous group. The QLQ-C30 and QLQ PR-25 scores did not show any statistically difference between the two ADT groups. CONCLUSIONS: No significant differences were seen in DP and QLQ between intermittent (6 months) and continuous (36 months) ADT in patients with BF after EBRT.
Assuntos
Antagonistas de Androgênios/uso terapêutico , Braquiterapia , Recidiva Local de Neoplasia/diagnóstico , Neoplasias da Próstata/tratamento farmacológico , Qualidade de Vida , Idoso , Terapia Combinada , Seguimentos , Humanos , Masculino , Gradação de Tumores , Recidiva Local de Neoplasia/sangue , Estadiamento de Neoplasias , Prognóstico , Estudos Prospectivos , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Fatores de TempoRESUMO
BACKGROUND: The optimal regimen of preoperative chemoradiotherapy for resectable esophageal cancer has not been established. We evaluated accelerated hyperfractionated radiotherapy (RT) concurrent to low-dose weekly cisplatin and continuous infusion fluorouracil (LDCI-FU) followed by esophagectomy in patients with locally advanced squamous cell carcinoma (SCC) of the esophagus. METHODS: Patients with clinical stage II or III SCC of the esophagus received cisplatin 30 mg/m2/week (days 1, 8, 15), LDCI-FU 300 mg/m2/day (days 1-21), and concomitant RT to a dose of 45 Gy (150 cGy/fraction, 2 fractions/day) on tumor and affected lymph nodes, followed by radical esophagectomy. RESULTS: From 1997 to 2012, 64 patients were treated with this regimen. Twenty-four patients (37 %) had grade 3 esophagitis, 18 (28 %) of whom required hospitalization. The risk of hospitalization was reduced by placement of a jejunostomy tube before starting induction chemoradiotherapy. Six patients (9 %) had grade 3-4 neutropenia. Fifty-three patients (83 %) underwent esophageal resection and complete resection was achieved in 45 (70 %). The overall median survival was 28 months (95 % CI: 20.4-35.6) and 5-year survival was 38 %. In the 18 patients attaining a pathological complete response, median survival was 132 months and 5-year survival was 72 %. Positron emission tomography standardized uptake values (PET SUVmax) post-chemoradiotherapy were associated with pathological response (p = 0.03) and survival (p = 0.04). CONCLUSIONS: Intensive preoperative hyperfractionated RT concomitant to low-dose cisplatin and LDCI-FU is effective in patients with locally advanced SCC of the esophagus, with good pathological response and survival and manageable toxicities. Post-chemoradiotherapy PET SUVmax shows promise as a potential prognostic factor.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/radioterapia , Quimiorradioterapia Adjuvante/métodos , Neoplasias Esofágicas/tratamento farmacológico , Neoplasias Esofágicas/radioterapia , Terapia Neoadjuvante/métodos , Adulto , Idoso , Carcinoma de Células Escamosas/cirurgia , Quimiorradioterapia Adjuvante/efeitos adversos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Intervalo Livre de Doença , Fracionamento da Dose de Radiação , Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago , Esofagectomia , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Tomografia por Emissão de PósitronsRESUMO
INTRODUCCIÓN: La combinación de embarazo y Neurofibromatosis tipo 1 (NF1) ha sido reportada con frecuencias de 1/2.500 a 1/18.500 partos. Patología con manifestaciones que van desde lesiones cutáneas, tumores o complicaciones ortopédicas. En la mujer esta enfermedad podría empeorar durante la gestación, debido a la cantidad de receptores esteroidales que tendrían los neurofibromas y la posibilidad de malignización de tumores del sistema nervioso central. PRESENTACIÓN DEL CASO: Mujer de 22 años, multípara de 1, con una perdida reproductiva a las 6 semanas de gestación, con antecedentes de NF1, un tumor cerebral tipo glioma temporal medial derecho y otro ubicado en nervio óptico izquierdo diagnosticados a los 17 años de edad, escoliosis lumbar operada a sus 13 años, controles con psiquiatra por discapacidad intelectual; además refiere que su madre y hermano presentan lesiones cutáneas compatibles con NF1, con total abandono de seguimiento hace 6 años. Inició sus controles con alto riesgo obstétrico al cursar la semana 22 de embarazo, se hospitalizó a las 37 semanas de gestación para mejorar la referencia y controles con especialistas. En el examen físico de ingreso destacó: escoliosis, estrabismo convergente de ojo derecho, lesiones hiperpigmentadas café con leche en dorso, extremidades inferiores, sin focalidad neurológica. Llegó a embarazo de término, realizándose parto vaginal a las 39semanas, con producto sexo femenino de 3360 gramos por 50 cm, adecuado para la edad gestacional, APGAR 9-10. DISCUSIÓN: Las pacientes embarazadas con NF1 contituyen un grupo de alto riesgo obstétrico, requieren de un equipo de trabajo multidisciplinario, consejería preconcepcional y de controles post parto
INTRODUCTION: The combination of pregnancy and Type 1 Neurofibromatosis (NF1) has been reported in rates of 1 in 2500 to 1 in 18500 deliveries. It's a disease with multiple manifestations such as skin damage, tumors or orthopedic complications. In women the disease may worsen during pregnancy, due to the amount of the neurofribromas' steroid receptors and the possibility of malignant transformation tumors of the central nervous system. CASE REPORT: 22 year old woman, with one previous satisfactory delivery, and a history of reproductive loss at 6 weeks gestation. She is diagnosed with NF1, showing a brain tumor, located in the right temporal medial side, glioma-type and other located in the left optic nerve diagnosed at 17 years of age, lumbar scoliosis operated at 13 years, psychiatrist controls with intellectual disabilities. Also, she relates that his mother and brother have skin lesions compatible with NF1, not keeping track six years ago. She began with high obstetrical risk unit controls at 22 weeks pregnant, then she was hospitalized at 37 weeks of gestation to improve reference and controls. In the physical first exam highlighted: scoliosis, convergent strabismus of the right eye, coffee with milk hyperpigmented lesions in the back, lower extremities without neurological deficit. She had a successful calving, performing vaginal delivery at 39 weeks, with a female of 3360 grams of weight and 50 cm height, appropriate for gestational age, APGAR 9-10. DISCUSSION: Pregnant patients with NF1 are a group of high-risk obstetrics, they require a multidisciplinary team of work, preconception counseling and birth controls after delivery
Assuntos
Humanos , Feminino , Gravidez , Complicações Neoplásicas na Gravidez/terapia , Neurofibromatose 1/complicações , Neurofibromatose 1/terapia , Resultado da Gravidez , Gravidez de Alto RiscoRESUMO
Introducción: En los últimos años han aparecido nuevos métodos para medir la temperatura en niños, como el termómetro digital ótico. Siendo este un método más rápido para medir la temperatura y por lo tanto ideal para el servicio de urgencias, es necesario conocer su confiabilidad. Objetivo: Comparar los valores de temperatura corporal que entrega el termómetro ótico digital con los termómetros de mercurio axilar y rectal. Pacientes y Método: Se efectuó la medición de la temperatura en 50 pacientes menores de 5 años elegidos al azar, que consultaron en el Servicio de Urgencia del Hospital de Niños y Cunas de Viña del Mar. Se les midió la temperatura con un termómetro digital ótico al lado izquierdo y derecho, y las temperaturas axilar derecha y rectal con termómetros de mercurio. EL análisis de los resultados se efectuó en el grupo estudiado, separado en dos grupos, menores y mayores de 6 meses. Resultados: Los resultados entre ambos subgrupos fueron los mismos. La temperatura media rectal obtenida fue 0,414°C más alta que la media ótica derecha (p < 0,001) y 0,438°C más alta que la temperatura media ótica izquierda (p < 0,001). Conclusión: El termómetro ótico digital entrega una temperatura significativamente más baja que la que entregan los termómetros de mercurio axilar y rectal.
Background: In recent years, otic thermometers to measure body temperature in children have become increasingly popular as they reflect changes in body temperature sooner than other thermometers. The have become valuable assets in hospital emergency rooms; however, their accuracy and reliability need further studies. Objective: To compare corporal temperature readings between an otic thermometer and mercury axillary and rectal thermometers. Patients and Method: 50 patients under the age of 5, who were treated at the emergency room of our hospital, were randomly chosen to participate in this study. Temperature was measured on their right and left ears using an otic thermometer, and their rectal and right axillary temperature was taken using mercury thermometers. Patients were separated into 2 subgroups for comparison, children under and over 6 months old. Results: The results between the 2 subgroups were very similar. The average temperature obtained by rectal thermometers was 0.414°C higher than the average right-ear temperature (p < 0.001) and 0.438°c higher than the average left-ear temperature (p < 0.001). Conclusion: The otic thermometer's reading is significantly lower than the one obtained using mercury rectal and axillary thermometers.
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Temperatura Corporal , Unidades de Terapia Intensiva Pediátrica , Termômetros , Fatores Etários , Axila , Febre , Hospitais Pediátricos , RetoRESUMO
BACKGROUND: Suicides account for a number of deaths that is higher than other traumatic deaths in Spain. Non-fatal suicidal behaviour occurs in a greater proportion than such behaviour with a deadly outcome. There are many causes for this behaviour and it is important to become familiar with them if it is to be prevented. The aim of this article is to describe the characteristics of non-mortal suicidal behaviour in the province of Granada. METHOD: A retrospective descriptive study of the characteristics of non-mortal suicidal behaviour in Granada during the years 2008 and 2009, according to the database of the Provincial 061 Service in Granada. The sample includes the demands made to this service in which the literal reason for the alert included the terms: suicide, self-harm or the threat of suicide. The statistical analysis was done with the SPSS 15.0 program. We analyzed the variable non-mortal suicidal behaviour with respect to the independent variables: sex, age, month, day of the week, time slot, health district, resolution of the demand (assigned priority) and further attempts. RESULTS: In total we analyzed 535 demands typified as intentional self-injury by unspecified means. Statistically significant differences were found when comparing the data for the two years with respect to the month chosen, and in the relationship between age range and time slot of the suicide attempts. CONCLUSIONS: Despite its limitations, the characterization of suicidal behaviour in our province offers essential information, and could be useful in designing and developing a program of psychosocial intervention for the prevention of suicidal behaviour adjusted to the specific profiles of our population.
Assuntos
Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Adulto JovemRESUMO
Objetivos: Caracterizar el síndrome HELLP en una población obstétrica de la décima Región de Chile. Método: Análisis de 33 pacientes con síndrome HELLP asistidas en el hospital de Puerto Montt, en el período 2000-2006. Resultados: La incidencia fue 1,3 casos por mil partos. La edad gestacional promedio de presentación fue de 33 semanas. En 84,8% de las pacientes el diagnóstico fue anteparto. El 27% de las pacientes recibió dexametasona. La principal complicación materna fue la insuficiencia renal aguda. El 91% de las pacientes presentó hipertensión arterial. No hubo muertes maternas. El peso promedio de los recién nacidos fue 2.048 gramos; 42% con edad gestacional menor a 34 semanas; 34,4% pesó menos de 1500 gramos; 9,4% presentó depresión neonatal severa a los 5 minutos; 12,1% falleció en el período neonatal. Conclusiones: El síndrome HELLP es una patología de baja incidencia y con elevada morbimortalidad neonatal.
Objectives: To characterize HELLP syndrome. Method: Analysis of 33 patients with HELLP syndrome assistedat the Puerto Montt hospital, in the period 2000-2006. Results: The incidence was 1.3 cases per thousand births. The average gestational age at presentation was 33 weeks; 84.4% of patient had prepartum diagnosis; 27% of patients received dexamethasone. The main complication was maternal acute renal failure. 91% of patients had hypertension syndrome. There were no maternal deaths. The average weight of newborns was 2,048 grams; 42% with gestational age less than 34 weeks; 34.4% weighed less than 1,500 grams; 9.4% had severe 5 minutes newborn depression; 12.1% died in the neonatal period. Conclusions: The HELLP syndrome is a disease of low incidence, with a high neonatal morbimortality.
Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto , Complicações na Gravidez/epidemiologia , Síndrome HELLP/epidemiologia , Índice de Massa Corporal , Estudos Transversais , Chile/epidemiologia , Dexametasona/uso terapêutico , Idade Gestacional , Incidência , Estado Nutricional , Resultado da Gravidez , Síndrome HELLP/tratamento farmacológicoRESUMO
In order to evaluate the independent effects of hydrodynamic conditions and/or oxygen tension on culture physiology and productivity, a fermentation system designed to control dissolved oxygen at constant power drawn (P/V) was developed. The system included a fully instrumented 14 l bioreactor coupled to a PC for data acquisition and control. Power drawn was measured (using a commercial torquemeter coupled to the shaft) and maintained constant by varying the agitation speed; while gas blending was used to control dissolved oxygen concentration. To validate the system, rheological-complex fermentations involving xanthan gum production and filamentous fungal cultivation (using Xanthomonas campestris and Trichoderma harzianum) were developed. In both cases, and despite the changing environmental conditions (due to increased broth viscosities and microbial respiration), both variables were controlled at the desired set points. Through such a system, a rigorous evaluation of the hydrodynamic conditions and/or oxygen tension on culture physiology and productivity is now feasible.
Assuntos
Reatores Biológicos/microbiologia , Técnicas de Cultura de Células/instrumentação , Análise de Injeção de Fluxo/instrumentação , Oxigênio/metabolismo , Reologia/instrumentação , Processamento de Sinais Assistido por Computador/instrumentação , Técnicas de Cultura de Células/métodos , Proliferação de Células , Desenho de Equipamento , Análise de Falha de Equipamento , Análise de Injeção de Fluxo/métodos , Reologia/métodos , Trichoderma/fisiologia , Xanthomonas/fisiologiaRESUMO
Objetivos: Describir patologías obstétricas asociadas, manejo perinatal y pronóstico neonatal del recién nacido de muy bajo peso al nacer (RNMBPN). Método: Estudio transversal efectuado en el Hospital de Puerto Montt, Chile, en 347 RNMBPN, en el periodo 2000 - 2005. Resultados: La incidencia de RNMBPN fue de 1,59 por ciento. El 70 por ciento de las pacientes recibió corticoides prenatales. La principal causa de interrupción fue el síndrome hipertensivo del embarazo. El 68,5 por ciento de los partos fueron por cesárea. El 23,7 por ciento y 9,3 por ciento presentó depresión neonatal severa al minuto y cinco minutos de vida, respectivamente. La cesárea se asoció a una reducción significativa del riesgo de depresión neonatal severa y muerte neonatal. Las principales complicaciones neonatales fueron el síndrome de dificultad respiratoria (61,5 por ciento) y sepsis neonatal (24,7 por ciento). El 29,7 por ciento de los recién nacidos fallece. Las causas de muerte son la prematurez (44,7 por ciento), las infecciones (30,1 por ciento) y las malformaciones congénitas (14,6 por ciento). Conclusiones: En nuestro centro el manejo los RNMBPN presentó un aumento significativo del uso de corticoides antenatales, de surfactante y asistencia ventilatoria con CPAP nasal. Hubo una reducción significativa de la depresión neonatal severa a los 5 minutos de vida. La sobrevida neonatal presentó un aumento significativo en el cuartil de 500 a 749 gramos. La cesárea se asocia a una disminución significativa de la depresión neonatal severa y muerte neonatal.
Objective: To describe obstetric morbidity, perinatal management and neonatal outcome in very low birth weight new born (VLBWNB). Method: Cross-sectional study in the Puerto Montt Hospital in 347 VLBWNB, from 2000 to 2005. Results: The VLBWNB incidence was 1.59 percent. 70 percent of the patients received prenatal corticoids. The main cause of interruption was hypertensive disorders; 68.5 percent of births were by caesarean delivery; severe neonatal depression occurred in 23.7 percent and 9.3 percent by Apgar score at one and five minutes respectively. The caesarean delivery Odds ratio for severe neonatal depression and neonatal death was 0.41 (IC 95 percent=0.25-0.70) and 0.43 (IC 95 percent=0.26-0.70), respectively. The main neonatal complications were respiratory distress syndrome (61.5 percent) and neonatal sepsis (24.7 percent), 29.7 percent of the new born died. The main mortality causes were prematurity (44.7 percent), infections (30.1 percent) and malformations (14.6 percent). Conclusions: At the evaluated period, the management of VLBWNB at our hospital presents a significant increment in antenatal corticoids administration, surfactant and nasal CPAP use. Also presents a significant reduction of severe neonatal depression at five minutes in Apgar score. The neonatal survival shows a significant increment in 500 to 749 g of birth weight cuartil. Caesarean section was associated with significant diminution of severe neonatal depression and neonatal death in VLBWNB.
Assuntos
Humanos , Feminino , Recém-Nascido , Adolescente , Adulto , Recém-Nascido de muito Baixo Peso , Índice de Apgar , Análise Multivariada , Estudos Transversais , Chile/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/terapia , Idade Gestacional , Mortalidade Infantil , Nascimento Prematuro/epidemiologia , Prognóstico , Fatores de Risco , Nascido Vivo/epidemiologia , Taxa de SobrevidaRESUMO
Se presenta la revisión de 25 pacientes con histerectomía obstétrica (HO) periparto ocurridas en el Hospital de Puerto Montt en el período 2000 - 2005. En 24 casos (96 por ciento) el parto fue por operación cesárea. El riesgo de HO periparto es 56 veces mayor en los partos cesárea que en los partos vaginales. Las principales causas de interrupción fueron cicatriz de 2 o más cesáreas en las cesáreas electivas y en las cesáreas urgentes la metrorragia del tercer trimestre. La principal causa clínica de HO es el acretismo placentario en 12 casos (48 por ciento) seguido de atonía uterina en 8 casos (32 por ciento). El estudio histológico se hizo en el 76 por ciento de los casos de los cuales el 80 por ciento confirma acretismo placentario. La HO total se realizó en 13 casos (52 por ciento) y subtotal en 12 casos (48 por ciento). El tiempo operatorio promedio fue de 124,3 + - 37,8 minutos. El hematocrito post operatorio tiene un descenso menor en las pacientes con HO subtotal que en la total (p< 0,05). La principal complicación fue la lesión vesical, que ocurrió en mayor proporción en el grupo de la HO total versus la subtotal (3:1), sin diferencias significativas. No se registró muerte materna asociadas a HO; hubo 4 muertes neonatales, 3 en relación a sufrimiento fetal agudo por metrorragia del tercer trimestre y 1 por infección ovular.
Assuntos
Feminino , Gravidez , Adulto , Humanos , Histerectomia/estatística & dados numéricos , Período Pós-Parto , Procedimentos Cirúrgicos Obstétricos/estatística & dados numéricos , Chile , Estudos Transversais , Cesárea/estatística & dados numéricos , Complicações na Gravidez/cirurgia , Hemorragia Pós-Parto/cirurgia , Complicações Pós-Operatórias , Tratamento de Emergência/métodosRESUMO
Chlamydophila abortus is the aetiological agent of enzootic abortion in small ruminants in which it infects the placenta to cause abortion during the last trimester of gestation. In a mouse model, a Th1 immune response involving IFN-gamma production and CD8+ T cells is necessary for the infection to be resolved. The authors previously demonstrated that infection with Nippostrongylus brasiliensis, a rodent gastrointestinal nematode extensively used in experimental models to induce Th2 responses, alters the specific immune response against C. abortus infection, increasing bacterial multiplication in liver and reducing specific IFN-gamma production. The aim of the present work was to clarify whether a Th2 immune response has any influence on the success of vaccination using both inactivated and attenuated vaccines. The results showed that the Th2 response established prior to vaccination did not influence the induction of protection offered by the vaccines. However, the effectiveness of this protective response can be altered, depending on the adjuvant employed in the inactivated vaccines, when the Th2 response is established after vaccination, just before challenge with C. abortus.
Assuntos
Vacinas Bacterianas/imunologia , Infecções por Chlamydophila/prevenção & controle , Chlamydophila/imunologia , Nippostrongylus/imunologia , Infecções por Strongylida/imunologia , Células Th2/imunologia , Animais , Células Cultivadas , Infecções por Chlamydophila/complicações , Infecções por Chlamydophila/imunologia , Chlamydophila psittaci/imunologia , Citocinas/metabolismo , Feminino , Camundongos , Camundongos Endogâmicos C57BL , Baço/citologia , Infecções por Strongylida/complicaçõesRESUMO
Revisar la experiencia en trauma renal en el Hospital San Juan de Dios, Servicio de Salud Metropolitano Occidente. Se revisan todos los registros de alta con diagnóstico de trauma renal entre los años 1994 y 2000. Se estudian retrospectivamente todos los registros caracterizando pacientes por edad, sexo, tipo trauma, estudio imagenológico y necesidad de cirugía. Durante el período se hospitalizaron 20 pacientes con diagnóstico de trauma renal. Sus edades oscilan entre los 17 y 64 años (mediana 33), 17 (85 por ciento) corresponden a sexo masculino. 4 (20 por ciento) sufren trauma penetrante, todos ellos por arma blanca, 16 (80 por ciento) presentan trauma contuso, principalmente por accidente automovilístico y caída de altura (66 por ciento). Dieciséis pacientes fueron manejados conservadoramente. De los pacientes que fueron a cirugía, en 2 de ellos se realizó nefrectomía por trauma contuso en riñón patológico. Los otros 2 presentaban trauma penetrante y se realizó nefrorrafia. En 3 pacientes del estudio no se realizó TAC. De los 20 pacientes, 9 fueron GI, 8 GII, 1 GIII, 2 GIV. La experiencia de nuestro servicio reproduce lo publicado. El trauma renal es más frecuente en hombres 4:1, el trauma cerrado es responsable del 80 por ciento de los mecanismos, siendo su génesis los accidentes automovilísticos y caídas. Las lesiones penetrantes se asocian a traumas de mayor grado. El manejo conservador es una alternativa en pacientes con trauma renal penetrante bien etapificado.