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Introducción: Las metástasis cerebrales (MC) representan una problemática importante de la salud pública, en promedio el 30% de los pacientes oncológicos desarrollarán MC siendo importante causa de morbilidad, ansiedad y mortalidad. El tratamiento con radioterapia, cirugía y sistémico son los pilares para el tratamiento y han tenido una evolución importante en la última década. Propósito de la revisión: Se proporciona información actualizada en relación a epidemiología, diagnóstico, pronóstico y tratamiento de metástasis cerebrales desde un enfoque multidisciplinariopara lograr individualizar su abordaje con el objetivo de proporcionar control oncológico y calidad de vida. También se discuten el acceso a nuevas terapias sistémicas, técnicas quirúrgicas y disponibilidad de tecnología para ofrecer técnicas avanzadas de radioterapia.Men saje principal: Conocer mutaciones específicas y receptores diana de los tumores permite elegir quimio-inmunoterapia o terapias dirigidas actuales que ofrecen mejor potencial de control tanto a nivel sistémico como intracraneal. La secuenciación de los tratamientos sistémicos y locales (cirugía, radio-cirugía, radioterapia holocraneal) deben ser discutidos desde un enfoque multidisciplinario Conclusión: Es importante poder estimar el pronóstico de los pacientes con MC, esto determinarla conducta terapéutica que puede variar desde cuidados sintomáticos hasta tratamientos más agresivos como resección neuroquirúrgica o radiocirugía.

In troduction:Brain metastases (BMs) represent a significant public health problem. An average of 30% of cancer patients develop BM, which is a significant cause of morbidity, anxiety, and mortality. Radio-therapy, surgery, and systemic treatment are the mainstays of treatment and have evolved significantly in the last decade.Pu rpose of the review: Updated information on the epidemiology, diagnosis, prognosis, and treatment of brain metastases from a multidisciplinary approach is provided to enable an individualized approach aimed at cancer control and quality of life. Access to new systemic therapies, surgical techniques, and availability of technology for advanced radiotherapy techniques are also discussed.Mai n message: Knowledge of specific mutations and targets of tumor receptors allows the selection of chemoimmunotherapy or current targeted therapies that offer better control potential at the systemic and intracranial levels. The sequence of systemic and local treatments (surgery, radiosurgery, whole brain radiation therapy) should be discussed as part of a multidisciplinary approach.C o nclusion: It is essential to estimate the prognosis of patients with BM, given that this will determine the therapeuticbehavior that can range from symptomatic care to more aggressive treatments such as neurosurgical resection or radiosurgery

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La incontinencia urinaria de urgencia corresponde a la pérdida involuntaria de orina, cuya causa es presumida multifactorial: hiperactividad del detrusor, hipersensibilidad vesical y distensibilidad reducida del detrusor. Esta patología es bastante frecuente tanto en Chile como en el mundo, con una prevalencia local entre 10% y 15%, a su vez genera un gran impacto en el bienestar físico, mental y socioeconómico del paciente. El diagnóstico es clínico, con apoyo en el uroanálisis y su tratamiento de primera línea puede ser realizado en APS. En cuanto al tratamiento existen tanto terapias no farmacológicas como farmacológicas; correspondiendo las técnicas de reentrenamiento vesical, los cambios de estilo de vida y los fármacos anticolinérgicos a tratamientos efectivos de primera línea. Existen, además, otros fármacos que pueden ser utilizados para el tratamiento de la IUU, cuya evidencia será igualmente revisada en este artículo.

Urge incontinence is defined as an involuntary leakage of urine, presumably with a multifactorial cause: detrusor overactivity, bladder hypersensibility and a reduced bladder compliance. It's a common disease worldwide, with local studies reporting a prevalence around 10-15%, causing a great impact in the physical, mental and socioeconomic well-being of the affected patients. Diagnosis is mainly based on the clinical history, supporting it with laboratory tests to rule out other conditions, and uncomplicated cases can be treated and followed in a primary care setting. There are pharmacologic and non-pharmacologic therapies, being healthy lifestyles changes, bladder retraining programs and anticholinergic drugs the first line of treatment. Additional pharmacologic treatments will be revised in this article.

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In 1995, severe symptoms were observed on 'Caturra' and 'Catuaí' coffee (Coffea arabica L.) varieties in farms in the southern part of the Central Valley in Costa Rica. Symptoms were reduced leaf size, malformation of leaves, curling of leaf edges, shortening of internodes, and severe leaf chlorotic mosaic, which sometimes became necrotic. Abortion of flowers and young beans was also observed, with a reduction in yield. Plants also showed irregular growth with an atypical curling appearance that gave rise to the Spanish name "crespera." Ten and three healthy plants were inoculated by grafting in the greenhouse, using infected and healthy budwoods, respectively. Approximately 6 months after inoculation, 3 of 10 grafted plants with infected budwoods showed symptoms of leaf chlorosis, curling, and malformation of leaves and bunched new flushes. Samples of 39 symptomatic plants collected from the field and samples of 3 healthy plants maintained in the greenhouse were tested by enzyme-linked immunosorbent assay (ELISA). All (100%) analyzed symptomatic samples were positive for X. fastidiosa, and all healthy controls were negative. The symptoms observed in Costa Rica are different from those described for coffee leaf scorch in Brazil (1,2), but the climatological conditions and soil type present in Costa Rica are also very different from the areas where X. fastidiosa occurs in Brazil. Leafhoppers were collected randomly in one of the most affected regions. Graphocephala permagna and Erythrogonia sonora were the most frequent insect species found associated with coffee. In ELISA, 34.5% (10 of 29) and 23.8% (5 of 21) of the collected specimens belonging to G. permagna and E. sonora, respectively, tested positive for X. fastidiosa. These positive ELISAs do not necessarily mean that the insect is a vector. The results presented here extend the known geographic distribution of X. fastidiosa. To our knowledge, this is the first report of X. fastidiosa in coffee in Costa Rica. References: (1) M. J. G. Beretta et al. Plant Dis. 80:821, 1996. (2) de Lima et al. Plant Dis. 82:94, 1998.